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cpeedahsa
Century Club
Joined: 21 Apr 2007
Posts: 792
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 Posted: Fri Jul 13, 2007 6:30 pm Post subject: |
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| Nick Raine-Fenning wrote: | Question 12
You are referred an anxious 15-year old with delayed puberty and anosmia. Her FSH level is 2.1 IU/L and her LH 0.8 IU/L. |
Pregnancy?
Last edited by cpeedahsa on Sat Jul 14, 2007 10:49 pm; edited 1 time in total |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1788
Location: Nottingham
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| Posted: Fri Jul 13, 2007 7:10 pm Post subject: |
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Hi cpeed - great to be doing some one to one work with you after all your efforts and fantastic posts this last few months.
I'll give you some clues to give the others time to answer.
Clue 1 - 50% right  |
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loupy
Joined: 11 Jul 2007
Posts: 5
Location: London
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| Posted: Fri Jul 13, 2007 7:55 pm Post subject: |
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| Nick Raine-Fenning wrote: | Question 15
Having recovered from the shock of the news you gave the lady in question 14 she then has to face another dilemma. Her youngest daughter has suddenly developed acne and facial hair. Examination reveals frontal balding. The mother is surprised as this did not happen with her other two children. |
H Congenital adrenal hyperplasia |
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wolverine
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Joined: 16 Jan 2007
Posts: 393
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| Posted: Fri Jul 13, 2007 7:57 pm Post subject: |
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| wolverine wrote: | | Question 4 FSH 0.5, LH 0.8, PRL 900IU/l, Oestradiol 1850nmol/l, Testosterone 2.7, progesterone 96. |
What about A. Pregnancy? There was a similar one in March and I answered pregnancy. (and I passed!..) I'm not sure about LH FSH but I think they are low as they are down regulated by the estrogens of the placenta and they are not needed as HCG takes over. |
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wolverine
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Joined: 16 Jan 2007
Posts: 393
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| Posted: Fri Jul 13, 2007 7:59 pm Post subject: |
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| Nick Raine-Fenning wrote: | Question 6
A 34-year woman is referred by her GP with secondary amenorrhoea. Examination is unremarkable but her test results show a raised prolactin (750 IU/L) and testosterone (3.0 nmol/L). |
I'd say PCOS (amenorrhea with evidence of biochemical hyperandrogenism) |
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wolverine
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Joined: 16 Jan 2007
Posts: 393
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| Posted: Fri Jul 13, 2007 8:03 pm Post subject: |
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| Nick Raine-Fenning wrote: | Question 7
You are referred a 15-year old girl as she has not started to menstruate and her parents are concerned. She has absent secondary sexual characteristics. |
Hypothalamic-pituitary dysfunction? |
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wolverine
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Joined: 16 Jan 2007
Posts: 393
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| Posted: Fri Jul 13, 2007 8:10 pm Post subject: |
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| Nick Raine-Fenning wrote: | Question 8
You are referred a 15-year old girl as she has not started to menstruate. Her parents, who are concerned, attribute this to her weight which is low at 45 kg. She is of normal height and has some breast development. Examination of her external genitalia reveals pubic hair and clitoromegaly. Abdominal ultrasound is normal. |
I was ready to agree with her parents and answer anorexia, when I saw her clitoris I thought of CAH |
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wolverine
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Joined: 16 Jan 2007
Posts: 393
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| Posted: Fri Jul 13, 2007 8:11 pm Post subject: |
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| Nick Raine-Fenning wrote: | Question 9
You are asked to see a 21-year old with secondary amenorrhoea. Her FSH and LH are low and she has an abdominal mass. |
Pregnancy!! if not pregnant then it could be oestrogen secreting tumour
Last edited by wolverine on Fri Jul 13, 2007 8:28 pm; edited 1 time in total |
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wolverine
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Joined: 16 Jan 2007
Posts: 393
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| Posted: Fri Jul 13, 2007 8:14 pm Post subject: |
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| Nick Raine-Fenning wrote: | Question 10
A 32-year old woman with irregular periods wants to conceive. She has acne and some facial hair but normal serum androgen levels and SHBG. A TV ultrasound scan shows normal ovaries. Her day 3 FSH is 8.0 IU/L and her LH 4.2 IU/L. |
Again PCOS Irregular periods with clinical evidence of hyperandrogenism
Give her some clomiphene Nick and she'll be fine |
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wolverine
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Joined: 16 Jan 2007
Posts: 393
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| Posted: Fri Jul 13, 2007 8:16 pm Post subject: |
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| Nick Raine-Fenning wrote: | Question 11
A 25-yar old woman is referred to the infertility clinic with secondary amenorrhoea. She complains of galactorrhoea and her prolactin is 850 IU/L. Her husband comments that her appearance has recently changed. She has had tingling in her fingers that did not improve when she had her rings cut off. |
I bet she's got big tongue as well! (poor husband..) Acromegaly |
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wolverine
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Joined: 16 Jan 2007
Posts: 393
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| Posted: Fri Jul 13, 2007 8:17 pm Post subject: |
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| Nick Raine-Fenning wrote: | Question 12
You are referred an anxious 15-year old with delayed puberty and anosmia. Her FSH level is 2.1 IU/L and her LH 0.8 IU/L. |
The anosmia is the clue. Kalmann's syndrome |
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wolverine
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Joined: 16 Jan 2007
Posts: 393
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| Posted: Fri Jul 13, 2007 8:24 pm Post subject: |
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| Nick Raine-Fenning wrote: | Question 13
You are asked to see a 34-year old woman who has not resumed menstruation following the birth of her daughter 8 months earlier. After an uneventful delivery she breast fed for 5 months but did suffer with post-natal depression which required admission to the mother and baby unit. |
?? hypothalamic pituitary dysfunction again? stress related?
Another thought is that Post-natal depression could also be a manifestation of post-partum thyroiditis which could cause menstrual irregularity although is more acute and earlier in post-natal period but sometimes it can persist or lead to hypothyroidism |
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wolverine
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Posts: 393
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| Posted: Fri Jul 13, 2007 8:32 pm Post subject: |
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| Nick Raine-Fenning wrote: | Question 14
You are asked to see a woman with secondary amenorrhoea and to review the results of the tests undertaken the previous month. Unfortunately her dog at the envelope with your letter in that outlined the findings! What uis the likely diagnosis.
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Basically you're asking what are the most common causes of secondary amenorrhea. Physiological: Pregnancy or menopause
another possible diagnosis is a constipated dog but it's not on your list |
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wolverine
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Posts: 393
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| Posted: Fri Jul 13, 2007 8:35 pm Post subject: |
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| Nick Raine-Fenning wrote: | Question 15
Having recovered from the shock of the news you gave the lady in question 14 she then has to face another dilemma. Her youngest daughter has suddenly developed acne and facial hair. Examination reveals frontal balding. The mother is surprised as this did not happen with her other two children. |
Key words are "suddenly" and "frontal balding" which points towards virilism. Therefore androgen secreting tumor is the answer (sertoli-leyding tumor). What a family... |
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loupy
Joined: 11 Jul 2007
Posts: 5
Location: London
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| Posted: Fri Jul 13, 2007 8:42 pm Post subject: |
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| wolverine wrote: | | Nick Raine-Fenning wrote: | Question 15
Having recovered from the shock of the news you gave the lady in question 14 she then has to face another dilemma. Her youngest daughter has suddenly developed acne and facial hair. Examination reveals frontal balding. The mother is surprised as this did not happen with her other two children. |
Key words are "suddenly" and "frontal balding" which points towards virilism. Therefore androgen secreting tumor is the answer (sertoli-leyding tumor). What a family... |
but would that be " sudden" - I'm not sure
Louise |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1788
Location: Nottingham
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| Posted: Fri Jul 13, 2007 8:47 pm Post subject: |
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HI wolverine - I wish you could see / hear me as I am laughing out aloud.
Great responses and correct in the majority of cases but not all 
You clearly have the right approach but then again you have been on our course(s) and you are a Member of the Royal College of Obstetricians & Gynaecologists so I would not expect anything less!
Few clues:
- if given a variety of viable options always go for the safest
- try and identify the key word or words in each and every EMQ - there is usually one thing (occasiobnally two) that make one answer more correct than the next
- critically consider the absolute levels of FSH/LH and related sex steroids in these scenarios - for example: does hypothalamic failure = low levels or absent levels???? |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1788
Location: Nottingham
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| Posted: Fri Jul 13, 2007 8:48 pm Post subject: |
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| loupy wrote: | | but would that be " sudden" - I'm not sure |
sudden = virilism
as do:
- voice change
- frontal balding
- clitiromegaly
- testosterone > 5.0 nmol/L
| wolverine wrote: | | Key words are "suddenly" and "frontal balding" which points towards virilism. |
Last edited by Nick Raine-Fenning on Fri Jul 13, 2007 8:59 pm; edited 2 times in total |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1788
Location: Nottingham
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| Posted: Fri Jul 13, 2007 8:48 pm Post subject: |
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| wolverine wrote: | | What a family... |
Are they that bad? Read the question and re-think |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1788
Location: Nottingham
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| Posted: Fri Jul 13, 2007 8:49 pm Post subject: |
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| wolverine wrote: | | The anosmia is the clue |
... or the red herring |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1788
Location: Nottingham
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| Posted: Fri Jul 13, 2007 8:52 pm Post subject: |
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| Quote: | | Question 4 FSH 0.5, LH 0.8, PRL 900IU/l, Oestradiol 1850nmol/l, Testosterone 2.7, progesterone 96. |
| wolverine wrote: | | What about A. Pregnancy? There was a similar one in March and I answered pregnancy. (and I passed!..) I'm not sure about LH FSH but I think they are low as they are down regulated by the estrogens of the placenta and they are not needed as HCG takes over. |
Interesting and very well thought out answer ... I think you are right! It did not make sense but I could not put an answer to it - yes you are absolutely right ... pregnancy - silly me  |
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