uworld qd 299 anyone plz ??

[sadaca]

Hey guys, if anyone has uworld , would u be so kind to explain this q to me plz? Its qd 299, on progesterone . I have read this explanation so many times and I just don't get it! Here you are giving the patient progesterone but in the explanation it says you are withdrawing??

I would realllyy appreciate your help

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[acciddropping]

I have not seen the question ... but it sounds like it's a Progesterone withdraw test to see if the ovary is working but no ovulation. To do that, you give a progesterone and then stop it and see she gets menses.

So, when a female gets no menses, there could be many reasons - 1) ovary is not functional and that means no estrogen coming out from the ovary or 2) anovulation or 3) uterus itself is a problem.

To figure out what the exact cause is, you will do several withdrawl test (again, this also requires the understanding of menstrual cycle - estrogen coming from ovary proliferates endometrium and progesterone that's released from corpus luetum after ovulation maintain that endometirum - when progesterone declines, then you get menses)

So, when you give Prrogesterone and stop it, and she gets menses, that means she has good ovary (hence, estrogen) but anovulation (hence, no endogenous progesterone and hence, no menses) -

if you give her progesterone and stop it, and gets NO menses, then you should give her "estrogen and progesterone" to see if she gets menses this time. If she does, then it means that her ovaries do not produce estrogen (like Turner syndrome). If she does not, then,.. the problem probably lies in uterus.

Hope that is what you are asking..

 

[sadaca]

hey friend! thanks for that. Could u explain , how come when u give progesterone she gets menses , especially since progesterone maintains pregnancy. So high progesterone means no menses.
Do you have uworld? If you do, you can just put the qd 299 in your search and this question will come up (if you have done most of the questions) . Or I could email you a pic of the question. B/c I think the question was asking something similar but not this exactly.

appreciate it

 

[acciddropping]

hey friend! thanks for that. Could u explain , how come when u give progesterone she gets menses , especially since progesterone maintains pregnancy. So high progesterone means no menses.
Do you have uworld? If you do, you can just put the qd 299 in your search and this question will come up (if you have done most of the questions) . Or I could email you a pic of the question. B/c I think the question was asking something similar but not this exactly.

appreciate it

i have UW and will get back to you when I get to my computer.

 

[sadaca]

Thanks I appreciate it

 

[acciddropping]

Thanks I appreciate it

Q: 3mo hx of amenorrhea (it's secondary amenorrhea, is she pregnant? is it due to anovulation? early ovarian atresia?). Preg test is neg. So your ddx is either anovulation or ovarian atresia. To figure out which one, you give her Progesterone (mimicking that she had an ovulation and that corpus leuteum is producing Progesterone to maintain the endometrium lining that assumably been proliferated by estrogen). Normally, Corpus leuteum disintegrates in 14 days and so drop in progesterone causes spiral artery spasm - leading to slouching off of the cells/ hence bleeding menses. Likewise, after 10 days course of progestin, she's going to have menses ONLY IF her ovarian granulocyte secreted estrogen (recall that estrogen = endometrium proliferation). So, at the end of 10 days (ie. withdraw), she gets vaginal bleeding (slouching off her endometrial cells that's been set up by oestrogen).

Let me know if that makes sense.

Could u explain , how come when u give progesterone she gets menses , especially since progesterone maintains pregnancy. So high progesterone means no menses.

1) you won't give her Progesterone if she's pregnant because her corpus leuterum will be making progesterone that maitains pregnancy like you said.
2) Progesterone function is NOT to maintain pregnancy per say. Its function is to maintain uterine lining to prepare for pregnancy if there's one AND to inhibit estrogen induced endometrium proliferation (that's why it's good to give Progestin along with Estrogen replacement therapy - otherwise, those postmeno women are at risk of endometrial hyperplasia/ cancer)
3) She gets menses because of ENDING her 10 day course (if she keeps taking Progesterone, I would assume that she is not going to have menses)

 

[sadaca]

hey acciddropping! wow thanks alot buddy. really!

okay so the question was simply asking about menses and how you get endometrial shedding due to appotosis once progesterone goes down in your secretory phase. wow I got so confused!
So like u said they are giving progesterone to see the cause of amenorrhea (anovulation or ovarian atresia) I don't really get how giving progesterone will help u figure that out. In this case, what was the cause of her amenorrhea? I know ovarian atresia is simply when close to ur 14day only one follicle is released rest all undergo apoptosis .

Again thanks alot for clarfying that question. God bless

 

[acciddropping]

hey acciddropping! wow thanks alot buddy. really!

okay so the question was simply asking about menses and how you get endometrial shedding due to appotosis once progesterone goes down in your secretory phase. wow I got so confused!
So like u said they are giving progesterone to see the cause of amenorrhea (anovulation or ovarian atresia) I don't really get how giving progesterone will help u figure that out. In this case, what was the cause of her amenorrhea? I know ovarian atresia is simply when close to ur 14day only one follicle is released rest all undergo apoptosis .

Again thanks alot for clarfying that question. God bless

In this case, it's likely that she was not ovulating.