Advanced Health Assessment & Clinical Diagnosis in Primary Care 5th Edition by Joyce E. Dains - Test Bank

Advanced Health Assessment & Clinical Diagnosis in Primary Care 5th Edition by Joyce E. Dains – Test Bank

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Chapter 5: Amenorrhea

1. If amenorrhea is reported by the female patient, the clinician should attribute this to

until proven otherwise.

2. A 17-year-old female patient complains of amenorrhea for the last 8 months, weight gain, excessive hair growth on the arms and chest, and development of Pelvic examination is normal. The clinician should recognize these are signs of:

3..                 A 55-year-old woman complains of amenorrhea and hot flashes for the last 3 months. Pregnancy test is negative. The clinician should recognize that menopause is defined as the absence of menses for:

4. To confirm the diagnosis of amenorrhea due to menopause, blood should be drawn for hormones. Which are the changes that occur with menopause?

1. ANS: A

Last menstrual period is one of the most important questions to ask, particularly when prescribing medications, because many are contraindicated in pregnancy. If menstrual cycles are not regular, pregnancy should be ruled out first, and then other diagnoses  can be considered. The menstrual history includes any episodes of amenorrhea, menorrhagia (excessive bleeding at the time of   the menstrual cycle), metrorrhagia (bleeding at irregular noncyclic intervals), dysmenorrhea, and postmenopausal bleeding.

Amenorrhea has many causes, including pregnancy; anorexia nervosa; excessive exercise; low body fat; and disorders or tumors of the hypothalamus, pituitary gland, ovary, uterus, and thyroid gland.

2..                 ANS:        C

Anovulation may present with amenorrhea but also may present with dysfunctional uterine bleeding, polymenorrhea, or menorrhagia. The symptoms vary with the cause. Overweight may be seen with several of the causes, including hypothyroidism, polycystic ovarian syndrome, and pituitary and adrenal dysfunction. Underweight is seen in anorexia nervosa, excessive exercise, hyperthyroidism, or stress-induced anovulation. Hirsutism, acne, and other skin changes can be seen with imbalances in LH,   FSH, and androgens, as seen in polycystic ovary disease. Delayed puberty or regression of sexual characteristics is seen in hypopituitarism; galactorrhea can be the presenting symptom in pituitary tumors.

PTS:        1

3..                 ANS:        B

Menopause is the absence of menses for at least 6 months. Age of menopause varies greatly, although age 50 to 55 is the typical range of onset. Although the absence of menses in a woman around the age of 50 years is diagnostic for menopause, measurement of FSH, LH, and estradiol levels are helpful in confirming the diagnosis.

PTS:        1

4..                 ANS:        D

In menopause, FSH rises first and then LH rises, both greater than 100 mU/mL. A fall in estradiol is the last hormonal change that occurs with the decline of ovarian function. An estradiol level of less than 30 pg/mL indicates loss of ovarian function.