Secondary amenorrhea

Secondary amenorrhea

Q. 1

In a case of secondary amenorrhea who fails to get withdrawl bleeding after taking E and P, the fault lies at the level of :

 A

Pituitary

 B

Hypothalamus

 C

Ovary

 D

Endometrium

Q. 1

In a case of secondary amenorrhea who fails to get withdrawl bleeding after taking E and P, the fault lies at the level of :

 A

Pituitary

 B

Hypothalamus

 C

Ovary

 D

Endometrium

Ans. D

Explanation:

Ans. is d i.e. Endometrium   

Read the question carefully, it says absence of withdraw! bleeding after estrogen-progesterone challenge test.

Oestrogen progesterone challenge test

Procedure : Ethinyl estradiol (.02 mg) or conjugated equine estrogen (1.25 mg) is given daily for 25 days. Medroxy progesterone acetate 10mg daily is added from day 15 – 25 (Alternatively estrogen is given for 21 days and progesterone is added in last 5 days).

The test creates a condition similar to normal Menstrual cycle

Withdraw! bleeding occurs

Means endometrium and outflow tract are normal and if provided by normal hormonal levels, result in menstruation.

Defect lies in production of estrogen i.e. either in ovare/Pituitarya/Hypothalamus

No withdraw! bleeding

Means their is a defect in endometrium° or outflow tract° (As despite normal hor­monal sequence no bleeding occurs).


Q. 2

In secondary amenorrhea the cause could be :

 A

Stein leventhal syndrome

 B

Premature ovarian failure

 C

Imperforate hymen

 D

Option A and B both

Q. 2

In secondary amenorrhea the cause could be :

 A

Stein leventhal syndrome

 B

Premature ovarian failure

 C

Imperforate hymen

 D

Option A and B both

Ans. D

Explanation:

Option A and B both


Q. 3

Commonest cause of secondaryamenorrhea is :

 A

TB

 B

Pregnancy

 C

Post pill amenorrhea

 D

Anaemia

Q. 3

Commonest cause of secondaryamenorrhea is :

 A

TB

 B

Pregnancy

 C

Post pill amenorrhea

 D

Anaemia

Ans. B

Explanation:

Pregnancy


Q. 4

A lady presented with secondary amenorrhea 6 months after having an abortion. Her FSH levels were measured as 6 mlU/ml what is the most probable diagnosis:

 A

Pituitary failure

 B

Ovarian failure

 C

Fresh pregnancy

 D

Uterine synechiae

Q. 4

A lady presented with secondary amenorrhea 6 months after having an abortion. Her FSH levels were measured as 6 mlU/ml what is the most probable diagnosis:

 A

Pituitary failure

 B

Ovarian failure

 C

Fresh pregnancy

 D

Uterine synechiae

Ans. D

Explanation:

Since the lady in the question is having secondary amenorrhea following an abortion, uterine synechiae is the most likely cause.

Low normal FSH level is consistent with uterine abnormality. (Normal serum FSH value in adult is woman is 5-20 mlU).

 
Ref: Novak’s, 14th Edition, Chapter 27; Speroff,  7th Edition, Chapter 11; Shaw’s, 14th Edition, Pages 263, 264; The Subfertility Handbook : A Clinician’s Guide By Gab Kovacs, 2nd Edition, Page 117

Q. 5

Female with secondary amenorrhea with serum prolactin level 75 ng/ml is to be treated with ‑

 A

Cabergoline

 B

Ganirelix

 C

Clomiphene

 D

Estradiol

Q. 5

Female with secondary amenorrhea with serum prolactin level 75 ng/ml is to be treated with ‑

 A

Cabergoline

 B

Ganirelix

 C

Clomiphene

 D

Estradiol

Ans. A

Explanation:

Ans. is ‘a’ i.e., Cabergoline


Q. 6

A young women with secondary amenorrhea and galactorrhea. MRI shows a tumour of < lOmm diameter in the pituitary fossa. Treatment is:

 A

Hormonal therapy for withdrawal bleeding

 B

Radiotherapy

 C

Chemotherapy

 D

Bromocriptine

Q. 6

A young women with secondary amenorrhea and galactorrhea. MRI shows a tumour of < lOmm diameter in the pituitary fossa. Treatment is:

 A

Hormonal therapy for withdrawal bleeding

 B

Radiotherapy

 C

Chemotherapy

 D

Bromocriptine

Ans. D

Explanation:

Answer is D (Bromocriptine):

Secondary Amenorrhea and galactorrhea in a young women with evidence of microadenoma (tumor I Omm) in the pituitary fossa suggest a diagnosis of prolactinoma.

Oral dopamine agonists (Dopamine or Cabergoline) are the treatment of choice for patients with prolactinomas.



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