Tiêu đề GYNE Amenorrhea July 2025 (FOR DISTRIBUTION).pdf ✅

20th OBGYN ORAL EXAM REVIEW ORAL SIMULATION 1 University of the Philippines-Manila, College of Medicine Philippine General Hospital Department of Obstetrics and Gynecology ORAL SIMULATION EXAM JULY 2025 EXAMINER’S COPY (Amenorrhea) Name of Examinee: Name of Examiner: A 23-year-old G0 consults due to absence of menstruation for the past 10 months. Her menses started at age 12 and were previously regular. She is a competitive long-distance runner and a university student preparing for board exams. She reports a 6 kg weight loss over the past 4 months due to stress and restrictive eating. No galactorrhea, acne, or hirsutism noted. She denies sexual activity. Physical exam shows a BMI of 17.8, Tanner stage 5 breast and pubic hair development, and normal external genitalia. No pelvic masses noted on bimanual exam. Points Score 1. What are your differentials? • Hypothalamic dysfunction • Hyperprolactinemia • Thyroid dysfunction • Polycystic ovary syndrome • Pregnancy 1.5 POINTS 0.3 0.3 0.3 0.3 0.3 2. What initial diagnostics tests will you request for? Give 5. • Pregnancy test • TSH • Prolactin • FSH • LH • Estradiol 1.5 POINTS 0.3 0.3 0.3 0.3 0.3 0.3
20th OBGYN ORAL EXAM REVIEW ORAL SIMULATION 2 LABORATORY RESULTS: β-hCG: negative FSH: low-normal LH: low Estradiol: 28 pg/mL Prolactin: 12 ng/mL (Normal: 4.8–23.3 ng/mL) TSH: 2.1 μIU/mL (Normal: 0.4–4.0 μIU/mL) Points Score 3. What is your diagnosis? • Secondary amenorrhea • Hypothalamic dysfunction • Gravida 0 1 POINT 0.33 0.33 0.33 4. What are the key etiologic factors for functional hypothalamic amenorrhea? Give 2. • Energy deficit due to caloric restriction • Excess exercise • Psychological stress 1.5 POINT 0.5 0.5 0.5 5. What is the underlying pathophysiology of FHA? • Suppression of pulsatile GnRH secretion due to hypothalamic inhibition from energy deficiency, stress, or overexercise • Decreased FSH and LH → anovulation and hypoestrogenism 1 POINT 0.50 0.50