532 obstetrics and Gynecology Board review •••
❍ What bad habit is associated with ovarian failure?
Cigarette smoking.
❍ Why might someone living in Alma, Colorado, undergo menopause earlier than someone in Philadelphia,
Pennsylvania?
Living at high altitude has been shown to be associated with premature ovarian failure—Alma, Colorado, is the
highest town with permanent residents in the United States.
❍ What radiation dose will permanently sterilize 100% of women?
over 800 rads.
150 rads will give some risk to women over 40. Using 200 to 500 rads, 60% of women aged 15 to 40 will be
sterilized. With 500 to 800 rads, 70% of women aged 15 to 40 will be sterilized.
(younger age = increased resistance to radiation)
❍ Which chemotherapeutic agents are most toxic to the ovaries?
Alkylating agents because they can affect both resting and dividing cells.
❍ What drug, though controversial, may offer protection against chemotherapy-induced ovarian follicular
depletion?
GnrH agonists.
❍ How does hysterectomy contribute to an increased incidence of early menopause?
The approximate two times increased incidence is thought to occur from disrupting the ovarian blood flow during
surgery.
❍ Genetic disorders (ie, mosaicism and deletions) account for a number of patients with premature ovarian
failure. What region of the X-chromosome is critical to prevent ovarian failure prematurely?
Xq26-28.
❍ Name the causes of obstructive amenorrhea.
Imperforate hymen, transverse vaginal septum, hypoplasia or absence of the uterus, and cervix and/or vagina.
❍ What test can help delineate the female anatomy the best?
MrI.
❍ How does one differentiate a transverse vaginal septum from an imperforate hymen?
A transverse vaginal septum lacks distention at the introitus with Valsalva maneuver.
❍ What is the treatment of a vaginal septum?
Surgical removal followed by Frank dilators to distend the vagina and prevent vaginal stenosis.
❍ The majority of vaginal septums occur in what two areas of the vagina?
The upper one third (46%) and the middle one third (40%).