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WorksheetsInfertility and Menstruation Disorders- Yero
Total questions: 40
Worksheet time: 30mins
JT is a 17-year-old female who complains of amenorrhea for 6 months. She experienced menarche at the age of 14 years. A pregnancy test is performed and found to be negative. She is a distance runner who describes her appetite as “healthy.” Her BMI is 21 kg/m2. What is the next step in evaluating this complaint?
Check her serum prolactin concentration
Check her thyroid-stimulating hormone (TSH) concentration
Quantify her level of exercise
Evaluate whether she may have anorexia
KS is a 36-year-old female who has not had a period for 8 months. She is not pregnant; her serum prolactin concentration is observed to be twice the upper limit of normal. She displays no symptoms of polycystic ovary syndrome (PCOS). Which of the following is most appropriate for KS at this time?
An oral contraceptive containing 30 µg ethinyl estradiol plus levonorgestrel
Bromocriptine 2.5 mg by mouth three times daily
Medroxyprogesterone acetate (MPA) 10 mg by mouth for 10 days
Metformin 1,000 mg by mouth twice daily
BJ is a 14-year-old girl who started having menses 7 months ago. Her menses is irregular, with cycle length ranging from 32 days to 75 days. What is the best course of action at this time?
Evaluate BJ for hypothyroidism
Evaluate BJ for polycystic ovary syndrome (PCOS)
Evaluate BJ for bleeding disorders
Educate BJ that her menstrual irregularity is expected
Which of the following statements is true regarding the levonorgestrel-releasing intrauterine system in women with heavy menstrual bleeding?
It should never be used in nulliparous women.
It reduces menstrual flow by a maximum of 25%.
It is a therapeutic option for any woman at low risk for sexually transmitted diseases.
Its use increases the need for hysterectomy.
Regardless of the etiology of amenorrhea, which of the following lifestyle interventions is most appropriate?
Increase the dietary intake of folate and vitamin E
Increase the dietary intake of calcium and vitamin D
Decrease the intake of alcohol
Decrease the level of exercise
In women with PCOS whose primary concern is menstrual irregularity, and who are not attempting pregnancy, which of the following is the initial therapeutic option after a trial of applicable lifestyle intervention?
Metformin
A combination oral contraceptive containing ethinyl estradiol and drospirenone
levonorgestrel-releasing intrauterine system
Letrozole
BB is a 32-year-old female who initially presented with complaints of irregular menses and excess hair growth around the jawline. She was diagnosed with PCOS and was started on an oral contraceptive and lifestyle modification. Today at her 6-month follow-up appointment, her BMI is 35 kg/m2, and her waist circumference is 40 inches (102 cm). A 2-hour oral glucose tolerance test suggests impaired glucose tolerance. Which of the following is the most appropriate option for BB at this time?
Continue her oral contraceptive
Discontinue her oral contraceptive and initiate a LNG-IUS
Discontinue her oral contraceptive and initiate letrozole
Add metformin
Hyperkalemia is most likely to result from which of the following products used in the management of PCOS?
A combination oral contraceptive containing ethinyl estradiol and drospirenone
A combination oral contraceptive containing ethinyl estradiol and levonorgestrel
Metformin 850 mg by mouth twice daily
Injectable medroxyprogesterone acetate (MPA), 150 mg dosed every12 weeks
JK has PCOS that was previously treated with a combined oral contraceptive. She has discontinued her oral contraceptive 14 months ago to attempt pregnancy. During these 14 months, she had two menstrual periods, both with heavy bleeding. Her pregnancy test today is negative. Which of the following is the most appropriate treatment?
Clomiphene 50 mg daily orally for 5 days
MPA 10 mg daily orally for 10 days
MPA 10 mg daily orally for 10 days, followed by letrozole 2.5 mg orally daily for 5 days beginning on cycle day 3 after induced withdrawal bleeding
MPA 10 mg daily orally for 10 days, followed by metformin 550 mg orally daily and titrated to 2,000 mg total daily dose
Excessive anovulatory bleeding in the adolescent population should result in an evaluation for
Hypoprothrombinemia
Hyperandrogenism
Hypoestrogenism
Hypothyroidism
Which of the following agents is most appropriate for the management of dysmenorrhea in an adolescent who is not sexually active?
Depot MPA 150 mg intramuscularly every 12 weeks
Ibuprofen 800 mg by mouth three times daily during menses
LNG-IUS releasing 20-µg levonorgestrel daily
Oral contraceptive with 35-µg ethinyl estradiol plus norgestimate daily
The most cost-effective treatment for heavy menstrual bleeding is
A combination oral contraceptive
LNG-IUS
Oral MPA
Depot MPA
Which of the following nonpharmacologic options is effective for the treatment of dysmenorrhea?
High protein diet
Topical ice packs
Reduced exercise
Topical heat
Dysmenorrhea is experienced by as many as _______% of women of childbearing age.
20
40
70
90
CO is a 30-year-old woman diagnosed with PMDD after charting her symptoms for two cycles and attempting nonpharmacologic interventions for her symptoms without much relief. She is married and does not wish to use any form of birth control. Which of the following agents would be most appropriate for managing CO’s PMDD?
Continuous treatment with paroxetine
Luteal phase treatment with fluoxetine
Luteal phase treatment with sertraline
90-µg levonorgestrel and 20-µg ethinyl estradiol dosed continuously for 12 months
__________dysmenorrhea is not due to any pelvic disease.
Primary
Secondary
What is the first line treatment for dysmenorrhea?
NSAIDs
Opiates
SSRIs
Oral Contraceptives
__________ amenorrhea is the absence of periods for at least 3 previous cycles or 6 months in those that have previously menstruated.
Primary
Secondary
Cyclic progestin can be used to induce monthly withdrawal bleeding and be used as contraception.
True
False
The underlying cause of amenorrhea is not important when determining the best treatment option.
True
False
What is the first line treatment for acute severe uterine bleeding ?
surgery
hormonal medication
iron supplement
NSAIDs
Which is highly effective for menorrhagia but can cause hot flushes, vaginal dryness, insomnia and can lead to osteoporosis after 6 months?
GnRH agonists
Levonorgestrel-Releasing Intrauterine System
Progestins
Combined Oral Contraceptives
How long should a patient use treatment with NSAIDs or oral contraceptive for dysmenorrhea before determining whether or not it is effective for them?
4 months
2 months
3 menstrual cycles
6 menstrual cycles
Endometriosis is the most common gynecological disease and is commonly diagnosed between age _________
30-50
20-40
50-70
16-30
Which of the following are symptoms of endometriosis?
Pelvic pain
Dysmenorrhea
Dyspareunia
Infertility
Dyschezia
What is the first approved treatment for endometriosis?
Danazol
GnRH
Progestin-only therapy
NSAIDs
Infertility is defined by the failure to achieve clinical pregnancy after_______ of regular, unprotected sexual intercourse.
12 months
6 months if older than 35
3 months
2 years
Which group of ovulation disorders is characterized by amenorrhea, low gonadotropins, and estrogen deficiency?
I
II
III
Which group of ovulation disorders is characterized by oligo-ovulation or anovulation; hyperandrogenism; polycystic ovaries on ultrasound scan and hyperprolactinemia amenorrhea?
I
II
III
Which group of ovulation disorders is characterized by amenorrhea and low estradiol?
I
II
III
What is the most common cause of infertility due to a tubal factor?
PID
STDs
Mass compression
Which of the following are nonpharmacological treatments for infertility?
Smoking cessation
Reduce or eliminate caffeine intake
Discontinue marijuana use
Clomiphene
Clomiphene
enhances normal follicular maturation process and ovulation
stimulates the ovary directly
stimulates release of gonadotropins
Increases levels of FSH and LH
Clomiphene treatment should be limited to
6 ovulatory cycles
3 ovulatory cycles
1 year
4 months
Blurred vision, diplopia, hot flashes, headache, and nausea are adverse effects of
Clomiphene
Letrozole
Anastrozole
Gonadotropins
Which is an injectable medication that act directly on the ovaries to induce follicular development?
Gonadotropins
Anastrozole
Letrozole
Clomiphene
Which is an oral medication that is used off label to block aromatase and lower estrogen levels augmenting secretion of LH and FSH?
Gonadotropins
Anastrozole
Letrozole
Clomiphene
Which of the following has an allergy alert for latex?
GnRH antagonists
Gonadotropins
Clomiphene
Letrozole
Chorionic gonadotropin (u-hCG) is given _______, and Choriogonadotropin alfa (r-hCG) is given _______
IM, SubQ
IV, IM
IM, IV
SubQ, IM
Which medication has a peanut allergy warning?
Progesterone
GnRH antagonist
Gonadotropins
Anastrozole
