TEALE FENNING Medical Education    FAQ   Search   Memberlist   Usergroups   Register   Profile   Log in to check your private messages   Log in  mrcog courses for doctors Endocrinonology:physiology and pathophysiology Goto page Previous  1, 2, 3, 4, 5  Next          TEALE FENNING Forum Index -> MRCOG Part 2: EMQs - Extended Matching Questions View previous topic :: View next topic   Author Message cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 788 Posted: Fri Jul 13, 2007 10:33 pm    Post subject: 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. Menopause I dont think it is pregnancy-- Why would anybody wait for a month to review the results if it was pregnancy. Most likely it is menopause Back to top stewartdisu Joined: 24 Jun 2007 Posts: 20 Posted: Fri Jul 13, 2007 11:21 pm    Post subject: prolactin prolactin 490-600U/L (Female) AND <450U/L (male) OXFORD TEXT BOOK OF MEDICINE Back to top stewartdisu Joined: 24 Jun 2007 Posts: 20 Posted: Fri Jul 13, 2007 11:50 pm    Post subject: question 14 Quote: 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 is the likely diagnosis. Menopause because she owns a dog, and is secondarily amenorrhoeric Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 393 Posted: Sat Jul 14, 2007 2:50 am    Post subject: Re: question 14 stewartdisu wrote: Menopause because she owns a dog, and is secondarily amenorrhoeric Abi? Should you start worrying? Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 393 Posted: Sat Jul 14, 2007 3:12 am    Post subject: Question 14: Pregnancy is much more common than premature menopause though. Why I say premature? because if she was 50 she wouldn't have investigations and because she was shocked by the results. Either a pregnancy or menopause could be shocking news for a 40 year old with three daughters and a dog! The fact that she forgets to feed the dog could indicate menopause but pregnancy can cause loss of memory too! Last edited by wolverine on Sat Jul 14, 2007 3:19 am; edited 1 time in total Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 393 Posted: Sat Jul 14, 2007 3:18 am    Post subject: Hi Nick! Are we, the veterans of March/May 07, still welcome in this forum? Although I try to abstain I'm still having withdrawal symptoms. And I really like EMQs! I think this is the future as it's the most objective way to assess knowledge. Plus that I find your questions very clever and entertaining. So I couldn't resist.. Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1742 Location: Nottingham Posted: Sat Jul 14, 2007 6:11 am    Post subject: wolverine wrote: Hi Nick! Are we, the veterans of March/May 07, still welcome in this forum? Although I try to abstain I cannot believe you even ask me that! Of course - you are not only welcome but needed. I was singing you and your Forum group's praises only yesterday on the ABC in O&G Course. Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1742 Location: Nottingham Posted: Sat Jul 14, 2007 6:13 am    Post subject: Re: prolactin stewartdisu wrote: prolactin 490-600U/L (Female) AND <450U/L (male) OXFORD TEXT BOOK OF MEDICINE Thanks Stewart - I've updated this thread with these values. Can you get some other reference ranges for us? Need all of endocrinology and anything else you think important. Last edited by Nick Raine-Fenning on Sat Jul 14, 2007 6:18 am; edited 1 time in total Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1742 Location: Nottingham Posted: Sat Jul 14, 2007 6:17 am    Post subject: Good discussion emerging here. I will deliberately not answer these until Monday to allow further discussion and debate. One piece of advice however, if in doubt always go for the safest answer - it generally works. 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 is the likely diagnosis. Dog = menopause Think again! Last edited by Nick Raine-Fenning on Sat Jul 14, 2007 9:34 am; edited 1 time in total Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 393 Posted: Sat Jul 14, 2007 7:50 am    Post subject: Hi Nick! I have posted some reference ranges on the Key facts in O+G Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 788 Posted: Sat Jul 14, 2007 2:28 pm    Post subject: Re: prolactin Nick Raine-Fenning wrote: stewartdisu wrote: prolactin 490-600U/L (Female) AND <450U/L (male) OXFORD TEXT BOOK OF MEDICINE Thanks Stewart - I've updated this thread with these values. Can you get some other reference ranges for us? Need all of endocrinology and anything else you think important. Prolactin- Female 0-20 ug/L(SI units) 1.9-25.9 ng/mL (Conventional units) These are the reference values for Prolactin in the 25th edition of Harrison's Medicine. Last edited by cpeedahsa on Sat Jul 14, 2007 4:24 pm; edited 1 time in total Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 788 Posted: Sat Jul 14, 2007 2:37 pm    Post subject: Analyte Specimen SI Units Conventional Units P= plasma; S= serum; U= urine; WB= whole blood Adrenocorticotropin (ACTH) P 1.3-16.7 pmol/L 6.0-76.0 pg/mL Androstenedione (adult) S 1.75-8.73 nmol/L 50-250 ng/dL Cortisol Fasting, 8 AM-Noon S 138-690 nmol/L 5-25 ug/dL Noon-8 PM 138-414 nmol/L 5-15 ug/dL 8 PM-8 AM 0-276 nmol/L 0-10 ug/dL Cortisol, free U 55-193 nmol/24 h 20-70 ug/24 h C-peptide (insulin) S 0.26-0.62 nmol/L 0.78-1.89 ng/mL Dehydroepiandrosterone (DHEA) (adult) Female 4.5-34.0 nmol/L 130-980 ng/dL DHEA sulfate S Female (adult, premenopausal) 120-5350 ug/L 12-535 ug/dL Female (adult, postmenopausal) 300-2600 ug/L 30-260 ug/dL Deoxycorticosterone (DOC) (adult) S 61-576 nmol/L 2-19 ng/dL 11-Deoxycortisol (adult) (compound S) (8:00 AM) S 0.34-4.56 nmol/L 12-158 ng/dL Dihydrotestosterone Female 0.14-0.76 nmol/L 4-22 ng/dL Estradiol S, P Female Menstruating Follicular phase 184-532 pmol/L <20-145 pg/mL Mid-cycle peak 411-1626 pmol/L 112-443 pg/mL Luteal phase 184-885 pmol/L <20-241 pg/mL Postmenopausal 217 pmol/L <59 pg/mL Estrone S, P Menstruating Follicular phase 55-555 pmol/L 1.5-15 pg/mL Luteal phase 55-740 pmol/L 1.5-20 pg/mL Postmenopausal 55-204 pmol/L 1.5-5.5 pg/mL Follicle-stimulating hormone (FSH) S, P Female Menstruating Follicular phase 3.0-20.0 IU/L 3.0-20.0 U/L Ovulatory phase 9.0-26.0 IU/L 9.0-26.0 U/L Luteal phase 1.0-12.0 IU/L 1.0-12.0 U/L Postmenopausal 18.0-153.0 IU/L 18.0-153.0 U/L Growth hormone (resting) S 0.5-17.0 ug/L 0.5-17.0 ng/mL Human chorionic gonadotropin (HCG) (nonpregnant) S <5 IU/L <5 mIU/mL 17-Hydroxyprogesterone (adult) S Female Follicular phase 0.6-3.0 nmol/L 20-100 ng/dL Midcycle peak 3-7.5 nmol/L 100-250 ng/dL Luteal phase 3-15 nmol/L 100-500 ng/dL Postmenopausal £2.1 nmol/L £70 ng/dL Luteinizing hormone (LH) S, P Female Menstruating Follicular phase 2.0-15.0 U/L 2.0-15.0 U/L Ovulatory phase 22.0-105.0 U/L 22.0-105.0 U/L Luteal phase 0.6-19.0 U/L 0.6-19.0 U/L Postmenopausal 16.0-64.0 U/L 16.0-64.0 U/L Progesterone S, P Female Follicular <3.18 nmol/L <1.0 ng/mL Midluteal 9.54-63.6 nmol/L 3-20 ng/mL Prolactin S Female 0-20 ug/L 1.9-25.9 ng/mL Sex hormone binding globulin (adult) S Female 18-114 nmol/L Testosterone, total, morning sample S Female 0.21-2.98 nmol/L 6-86 ng/dL Testosterone, unbound, morning sample Female, adult S 6.9-107.5 pmol/L 0.2-3.1 pg/mL Thyroglobulin S 0-60 ug/L 0-60 ng/mL Thyroid binding globulin S 206-309 ug/L 16-24 ug/dL Thyroid hormone binding index (THBI or T3RU) S 0.83-1.17 mol ratio 0.83-1.17 (Free) thyroxine index S 4.2-13 4.2-13 Thyroid stimulating hormone S 0.5-4.7 mU/L 0.5-4.7 uU/mL Thyroxine, total (T4) S 58-140 nmol/L 4.5-10.9 ug/dL Triiodothyronine, total (T3) S 0.92-2.78 nmol/L 60-181 ng/dL Thyroxine, free (fT4) S 10.3-35 pmol/L 0.8-2.7 ng/dL Triiodothyronine, free (fT3) S 0.22-6.78 pmol/L 1.4-4.4 pg/mL Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 788 Posted: Sat Jul 14, 2007 3:51 pm    Post subject: 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. Sertoli-Leydig cell tumors Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 788 Posted: Sat Jul 14, 2007 4:20 pm    Post subject: 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 (I would have wanted gonadal dysgenesis to be in the main list of options though!) Causes of primary amenorrhea 1)Chromosomal abnormalities causing gonadal dysgenesis-50% 2)Hypothalamic hypogonadism including functional hypothalamic amenorrhea-20% 3)Absence of uterus, cervix and/or vagina, müllerian agenesis-15% 4)Transverse vaginal septum or imperforate hymen-5% 5)Pituitary disease -5% In this case since secondary sexual characteristics are not pesent-- ovaries not functioning(either due to lack of gonadotropins or due to problem at the level of ovaries itself)! (So obviously cause 3 and 4 are ruled out) Remaining 5% of cases are due to a combination of disorders including androgen insensitivity due to mutations in the androgen receptor, congenital adrenal hyperplasia and polycystic ovary syndrome. Another cause of primary amenorrhea are steroid receptor abnormalities and deficiencies in enzymes of steroidogenesis. Last edited by cpeedahsa on Sat Jul 14, 2007 5:06 pm; edited 1 time in total Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 788 Posted: Sat Jul 14, 2007 4:59 pm    Post subject: 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 looked at this question again and I think the answer is a mixed pituitary adenoma. Going strictly by definition- It can be acromegaly as in that case she should have only GH elevation. Acromegaly -pituitary(or rarely any other gland/tumor) produces excessive amounts of GH. Usually the excess GH comes from benign, or noncancerous, tumors on the pituitary. These benign tumors are called adenomas. Acromegaly Greek words -“extremities” and “enlargement,” most common symptoms.Swelling of the hands and feet is often an early feature, change in ring or shoe size, particularly shoe width. Gradually, bone changes alter facial features: The brow and lower jaw protrude, the nasal bone enlarges, and the teeth space out. Overgrowth of bone and cartilage arthritis. Entrapment carpal tunnel syndrome, numbness and weakness of the hands. Heart, may enlarge. Other symptoms of acromegaly include joint aches thick, coarse, oily skin skin tags enlarged lips, nose, and tongue deepening of the voice due to enlarged sinuses and vocal cords sleep apnea—breaks in breathing during sleep due to obstruction of the airway excessive sweating and skin odor fatigue and weakness headaches impaired vision abnormalities of the menstrual cycle and sometimes breast discharge in women erectile dysfunction in men decreased libido In >95% people with acromegaly, a benign tumor of the pituitary gland, -adenoma, produces excess GH. Pituitary tumors -micro- or macro-adenomas, depending on their size. Most GH-secreting tumors are macro-adenomas. Depending on their location, these larger tumors may compress surrounding brain structures. For example, a tumor growing upward may affect the optic chiasm—where the optic nerves cross—leading to visual problems and vision loss. If the tumor grows to the side, it may enter cavernous sinus where there are many nerves, potentially damaging them. Compression of the surrounding normal pituitary tissue hormonal shifts can lead to changes in menstruation and breast discharge in women and erectile dysfunction in men. If the tumor affects the part of the pituitary that controls the thyroid—another hormone-producing gland—then thyroid hormones may decrease. Too little thyroid hormone can cause weight gain, fatigue, and hair and skin changes. If the tumor affects the part of the pituitary that controls the adrenal gland, the hormone cortisol may decrease. Too little cortisol can cause weight loss, dizziness, fatigue, low blood pressure, and nausea. Some GH-secreting tumors may also secrete too much of other pituitary hormones. -prolactin. Rarely, adenomas may produce thyroid-stimulating hormone. Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 788 Posted: Sat Jul 14, 2007 5:32 pm    Post subject: Nick Raine-Fenning wrote: Question 5 You are asked to review the results of a patient in the absence of your consultant. The results are as follows: FSH 35 IU/L LH 23 IU/L Oestradiol 12,458 pmol/L What is the likely diagnosis? I would think it is pituitary adenoma (A gonadotropin producing pituitary adenoma) In women with high FSH levels from a gonadotroph adenoma, a high FSH level may also lead to ovarian hyperstimulation. Gonadotroph adenomas- most common pituitary macroadenomas usually do not cause a recognizable clinical endocrine syndrome. They manifest as visual impairment, headaches, and deficiency of pituitary hormones due to compression of nonadenomatous pituitary cells by the macroadenoma. The gonadotroph adenoma itself can oversecrete FSH, LH, or one of the subunits (alpha or beta). Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1742 Location: Nottingham Posted: Sat Jul 14, 2007 6:34 pm    Post subject: Re: prolactin cpeedahsa wrote: Prolactin- Female 0-20 ug/L(SI units) 1.9-25.9 ng/mL (Conventional units) These are the reference values for Prolactin in the 25th edition of Harrison's Medicine. The problem with these values is that we do not use SI units! Prolactin in the O&G literature, and as far as I am aware most of the medical literature, uses U/L for Prolactin and the following guide: - > 450 U/L = raised - > 1000 U/L = need to image the head - > 1450 U/L = probable pituitary lesion - > 4500 U/L = probable macroprolactinoma Those are from memory so may be wrong but are in the ball park Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1742 Location: Nottingham Posted: Sat Jul 14, 2007 6:40 pm    Post subject: Nice answers and some great reasoning cpeed but I will stick with my plan and release the answers after the weekend. Come on guys - help cpeed and wolverine out Cpeed is doing all the work and therefore getting all the benefit and old wolverine is one of our veterans as he already has his MRCOG (after attending lots of TF Courses and being an active Forumite ). Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 788 Posted: Sat Jul 14, 2007 6:55 pm    Post subject: 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. I guess with normal levels of both FSH and LH -hypogonadotropic casue for delayed puberty is ruled out.!!! Anosmia truly is just a red herring. I am actually thinking of Pregnancy-- Is the word anxious --the clue? Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1742 Location: Nottingham Posted: Sat Jul 14, 2007 6:58 pm    Post subject: Getting closer Back to top Display posts from previous: All Posts1 Day7 Days2 Weeks1 Month3 Months6 Months1 Year Oldest FirstNewest First         TEALE FENNING Forum Index -> MRCOG Part 2: EMQs - Extended Matching Questions All times are GMT Goto page Previous  1, 2, 3, 4, 5  Next Page 4 of 5   Jump to: Select a forum Announcements----------------Forum AnnouncementsExam InformationCourse Announcements Examinations----------------MRCOG Part 1: EMCQsMRCOG Part 2: MCQ & Past Paper questionsMRCOG Part 2: EMQs - Extended Matching QuestionsMRCOG Part 2: Short Answer EssaysMRCOG Part 2: Objective Structured Clinical Examination - the OSCEDRCOG: the Diploma ExaminationMFFP: Membership of the Faculty of Family Planning and Reproductive Health Care of the RCOGPLAB: The Professional and Linguistic Assessment Board test General Discussion----------------Open ForumRCOG News & UpdatesThe Study Buddy SchemeKey Facts in O&GGuidelines & ProtocolsRecommended ReadingUseful WebsitesThe Market PlaceHow things work in the UKHow do you say that? Teale Fenning Courses----------------Our UK CoursesOur Overseas CoursesOur Correspondence CourseCourse AdministrationCourse FeedbackAccommodationOther Courses Training & Career Development----------------Basic Speciality Training in O&GSubspeciality Training & Special Skills ModulesAcademic TrainingResearch & AuditThe Curriculum Vitae or CVInterview SkillsMedical EducationPublication & Presentation SkillsTraining Courses, Conferences, & MeetingsThe Job MarketClinical Attachments  You cannot post new topics in this forum You cannot reply to topics in this forum You cannot edit your posts in this forum You cannot delete your posts in this forum You cannot vote in polls in this forum Powered by phpBB © 2001, 2005 phpBB Group