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NURG 603 MODULE 2 EXAM
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NURG 603 MODULE 2 EXAM 2024-2025Primary Amenorrhea - ANSWER -absence of menses by age 16
-absence of menses within 3 yrs. of thelarche
Secondary Amenorrhea - ANSWER absence of menses for 3-6 months or three
cycles after having at least one spontaneous menstrual period
What is the #1 cause of secondary amenorrhea? - ANSWER pregnancy
Causes of Amenorrhea - ANSWER -pregnancy
-hypothalamic-pituitary dysfunction
-ovarian dysfunction
-alteration of the genital outflow tract
Amenorrhea: Diagnosis & Treatment - ANSWER -thorough hx
-thorough physical assessment including Tanner's stage
-imaging studies depend on hx
-labs: pregnancy test, TSH, prolactin, FSH, & potentially genetic testing
-Treatment depends on the cause:
-start with a progesterone challenge test
-pts. desiring pregnancy = clomiphene citrate may be used to induce ovulation
What will a progesterone challenge help determine? - ANSWER this will help you
know if the pt. has adequate estrogen, a competent endometrium, and a patent
outflow tract
How do you do a progesterone challenge? - ANSWER you give your pt. a 10-14
day course of micronized progesterone and this should produce a w/drawl bleeding
w/in a week after completing the oral dose
,Abnormal Uterine Bleeding: ***Postmenopausal Women*** - ANSWER any
bleeding or spotting is presumed MALIGNANT until proven otherwise!!
U/S then refer for an endometrial biopsy
Abnormal Uterine Bleeding Falls into 2 Categories: - ANSWER Structural Causes:
PALM
-Polyp
-Adenomyosis
-Leiomyoma (submucosal myoma; other myoma)
-Malignancy and hyperplasia
Nonstructural Causes: COEIN
-coagulopathy
-ovulatory dysfunction
-endometrial
-iatrogenic
-not yet classified
Abnormal uterine bleeding: diagnosis - ANSWER -neoplasia must be excluded
-labs: pregnancy test, CBC, TSH, & cervical cancer screening (consider screening
for chlamydia)
-pelvic U/S or sonohysterography may help diagnose lesions
treatment goal: regulate uterine bleeding and ensure the endometrium sheds
regularly
Abnormal Uterine Bleeding: When to Refer - ANSWER -acute menorrhagia
-*bleeding severe enough to cause volume depletion
-SOB
, -fatigue
-palpitations
*this level anemia necessitates hospitalization, IV fluids, possible transfusion, &/or
IV estrogen therapy
pts. who do not respond may need surgery
-always make sure to assess bleeding by asking # of pads and tampons used per
hour
Polycystic Ovarian Syndrome: - ANSWER -hyperandrogenism, acne, hirsutism,
male-pattern hair loss, elevated serum androgens
-polycystic ovaries on ultrasound
-associated w/ obesity and insulin resistance
-menstrual dysfunction: oligomenorrhea or amenorrhea
-treatment options: weight loss, oral contraceptives, spironolactone
PCOS II (aka Stein/Leventhal Disease) - ANSWER *most common cause of
androgen excess & hirsutism
-etiology = unknown
-symptoms--> oligomenorrhea or amenorrhea, acne, hirsutism, infertility
-establishing diagnosis: oligo-ovulation or anovulation usually marked by irregular
menstrual cycles; biochemical or clinical evidence of hyperandrogenism
-acquisition of body fat coincides w/ onset of PCOS
PCOS: Diagnostic Studies - ANSWER -pregnancy test
-LH/FSH ration: increased
-Testosterone: upper limits of normal or increased
-Fasting insulin: elevated
-Prolactin: elevated
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