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Self-Assessment Questions

Obstetrics and Gynecology

Evaluation and Management of Amenorrhea: Review Questions

Jamil A. Fayez, MD

Dr. Fayez is Professor of Obstetrics and Gynecology, Reproductive Endocrinology Section, Wake Forest University School of Medicine, Winston-Salem, NC,
and a member of the Hospital Physician Editorial Board.

Choose the single best answer for each question.

1. In a nonpregnant woman, galactorrhea with amenorrhea (GA syndrome) is a pathologic condition that may be caused by a serious organic disease. Which one of the following causes of GA syndrome is the most serious?
  1. Frequent breast manipulation
  2. Medications such as phenothiazines, reserpine, opiates, or amphetamines
  3. Primary hypothyroidism
  4. Adrenal tumor
  5. Pituitary tumor
Click here to compare your answer.

2. Which one of the following methods for treatment of prolactin-secreting pituitary tumors is the most efficient and acceptable to patients?

  1. Bromocriptine tablets administered orally
  2. Bromocriptine suppositories administered vaginally
  3. Cabergoline tablets administered orally
  4. Transsphenoidal resection of the tumor
  5. Irradiation
Click here to compare your answer.

3. A 24-year-old, married, nulligravida female runner presents to her gynecologist because of cessation of menses for 2 years. She says that she has been running regularly for more than 3 years, and for the past year she has been running 55 miles per week. She has been using an intrauterine device (IUD) for 3 years. Physical and gynecologic examinations are normal, and no hirsutism or galactorrhea is noted. She is 5 ft 4 in tall and weighs 116 lb. She has no withdrawal bleeding after treatment with medroxyprogesterone acetate, and her serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels are low. Which of the following statements is correct?

  1. The patient has premature ovarian failure.
  2. The patient has polycystic ovary disease (PCOD).
  3. The patient has hypothalamic amenorrhea.
  4. The patient has intrauterine synechiae secondary to IUD use.
  5. Magnetic resonance imaging (MRI) of the pituitary gland is essential for the final diagnosis.
Click here to compare your answer.
4. Which of the following patients is most likely to develop Sheehan’s syndrome?
  1. A patient with polycystic ovaries who has irregular menstrual periods and bleeds heavily with clots when she has a menstrual flow
  2. A patient who has hyperthyroidism
  3. A patient with congenital adrenal hyperplasia
  4. A patient with severe postpartum hemorrhage
  5. A patient who had two uterine curettages in 1 week because of menometrorrhagia
Click here to compare your answer.

5. A 16-year-old girl presents with her mother to the gynecologist because her menstrual periods have not started. History reveals that the patient’s mother and older sister started their menstrual periods at age 13 years. Physical examination reveals normal breast size and normal pubic and axillary hair. The patient is 5 ft 3 in tall and weighs 120 lb. What is the most probable diagnosis?

  1. Hypothalamic dysfunction
  2. Pituitary dysfunction
  3. Testicular feminization syndrome
  4. Imperforate hymen
  5. Rokitansky-Küster-Hauser syndrome (vaginal and uterine agenesis)
Click here to compare your answer.

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