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history, bimanual examination, and Pap smear A TSH may also be ordered as thyroid disease can affect bleeding patterns In each scenario, what additional tests should be done and why An ovulatory woman Transvaginal ultrasound, sonohysterogram, or D&C with hysteroscopy (gold standard) should be done to rule out anatomic causes of abnormal bleeding -hCG: pregnancy CBC: infection Coagulation profile: blood dyscrasia Endocrine tests (FSH, LH, TSH, prolactin): premature ovarian failure, polycystic ovarian syndrome (PCOS), prolactinoma, hypothyroidism All postmenopausal women What are the risks of unrecognized DUB What is the goal of treatment for DUB Endometrial biopsy: endometrial carcinoma Hemorrhage, endometrial hyperplasia, and/or cancer To convert the proliferative endometrium into secretory endometrium Anovulatory DUB is treated with OCPs or cyclic progesterone therapy (such as medroxyprogesterone daily for 10 days of each month) DUB associated with heavy bleeding is treated with high-dose estrogen or progestins Endometrial ablation can also be used for treatment if patient is refractory to oral and IV estrogen therapy A D&C can be done if patient is hemodynamically unstable How is ovulatory DUB treated Ovulatory DUB is treated primarily with OCPs

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eye on them Sometimes developers miss deadlines, which screws up the publisher s shipping schedule and causes them to break promises to the retailers, who are expecting to get the game by a given date In extreme cases, the developer may go out of business, leaving the publisher with a half-finished game and no way to complete it The publisher says, We ve got to get some control back here keep this process where we can see it on a day-to-day basis Let s bring all our development in-house So the publisher goes out and hires a lot of programmers and writers and artists and musicians, and everything goes along well for a while until somebody notes that there is a huge number of people on staff, all drawing pay and consuming office space and taking vacations and requiring benefits and wanting stock options and bonuses It s costing the company a fortune So this person says to the management, You know, there are people out there who would work for half this much money if we pay them on contract We wouldn t have to provide all these nice benefits; we can give them just barely enough to stay alive with a promise of royalties when the game turns a profit They ll work their guts out for the prospect of getting rich, and we won t have all this overhead Management likes the idea, they duly get rid of all their in-house developers, and the cycle starts all over again This cycle typically takes about two to five years to run, and it depends on how good the management s corporate memory is If someone suggests it too soon, there will be someone else around who says, Oh, no, we had that system [whichever system] a year ago and it was a nightmare But if there s turnover in the senior staff, then the new ones don t know that it was a nightmare, and they go round again.

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What is amenorrhea and what are the two subtypes Amenorrhea is the absence of menstruation It can be subdivided into two subtypes If a woman has never menstruated, she has primary amenorrhea, whereas if she has previously menstruated but has failed to menstruate within 6 months or for 3 cycle intervals she has secondary amenorrhea Pregnancy: Since it is the most common cause of amenorrhea, this is an essential diagnosis to exclude via a pregnancy test Hypothalamic-pituitary dysfunction: When the pulsatile secretion of GnRH is altered, the pituitary gland ceases secreting FSH and LH This results in the absence of regular ovulation and menstruation Most hypothalamic-pituitary dysfunction is of functional origin Ovarian dysfunction: The ovarian follicles are resistant to stimulation by FSH and LH Anatomic dysfunction: Genital outflow tract obstruction can be congenital or from the development of scar tissue The most common cause of obstruction is scarring of the uterine cavity (Asherman syndrome) What are the common causes of hypothalamic-pituitary dysfunction Functional: Weight loss Excessive exercise Obesity Drug induced: Marijuana Sedatives Malignancy: Prolactinoma Craniopharyngioma Hypothalamic hamartoma Psychogenic: Anxiety Anorexia Other: Head injury

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List the differential diagnoses for the pregnant woman who presents with acute lower abdominal pain Gynecologic etiologies: ruptured corpus luteum cyst; adnexal torsion; ectopic pregnancy; abruptio placentae; early labor; salpingitis Nongynecologic etiologies: pyelonephritis; cholecystitis; diverticulitis What is the most consistent clinical symptom encountered in pregnant women with appendicitis Signs and symptoms of acute appendicitis are not dramatic in the pregnant woman and also not as

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