Clinical management scenarios for menstrual disorders, infertility workup, and reproductive tract disease tested on USMLE Step 2 CK.
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- At what age is absence of menarche (with normal secondary sexual characteristics) considered primary amenorrhea?
- 15 years old
- What defines secondary amenorrhea?
- Absence of menses for 3 or more consecutive months in a woman with previously normal cycles
- What is the most common cause of primary amenorrhea?
- Turner syndrome (gonadal dysgenesis)
- What is the most common cause of secondary amenorrhea in a reproductive-age woman?
- Pregnancy
- What is the first test ordered in any woman presenting with secondary amenorrhea?
- Urine or serum beta-hCG (pregnancy test)
- The Rotterdam criteria for PCOS require ____ of 3 features: oligo/anovulation, hyperandrogenism, and polycystic ovaries on ultrasound.
- 2
- What gonadotropin ratio pattern is classically seen in PCOS?
- Elevated LH to FSH ratio
- What is first-line treatment for PCOS in a woman who does not desire pregnancy?
- Combined oral contraceptive pills
- What is the first-line agent for ovulation induction in a woman with PCOS who desires pregnancy?
- Letrozole
- What condition is caused by intrauterine adhesions, often after aggressive dilation and curettage?
- Asherman syndrome
- What is the diagnostic procedure of choice for Asherman syndrome?
- Hysteroscopy
- How is menorrhagia (heavy menstrual bleeding) defined in terms of blood loss?
- Greater than 80 mL of blood loss per menstrual cycle
- What is the most common cause of abnormal uterine bleeding in reproductive-age women?
- Anovulation
- What does the PALM-COEIN classification system organize?
- Causes of abnormal uterine bleeding, split into structural (PALM) and nonstructural (COEIN) categories
- What distinguishes primary from secondary dysmenorrhea?
- Primary has no identifiable pelvic pathology; secondary is caused by an underlying condition such as endometriosis