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* nbme-2
 #513968  
  gluck - 06/18/10 20:01
 
  5. An otherwise healthy 15-year-old girl is brought to the physician because she has never had a menstrual period. She reports that breast development started 1 year ago and pubic and axillary hair development began 6 months ago. Examination shows normal genitalia. Breast development is Tanner stage 4, and pubic hair development is Tanner stage 3. Which of the following is the most appropriate next step in management?

A) Reexamination in 1 year if the patient has not had menarche

B) Measurement of serum follicle-stimulating hormone and luteinizing hormone levels

C) Measurement of serum thyroid-stimulating hormone and prolactin levels

D) Karyotype analysis

E) Progesterone withdrawal test

F) Pelvic ultrasonographypolypeptide levels
 
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* Re:nbme-2
#2131754
  thirstysoul - 06/18/10 20:58
 
  b.....???  
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* Re:nbme-2
#2131766
  forever07 - 06/18/10 21:10
 
  A
def of primary amoenorrhoea-
14 yrs without 2 sex development
but, 16 yrs with secondary sex dev.

This pt 15 yr old, with full 2 sex character.
Re examine in 1 yr and do full inv if she has not had menarche
 
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* Re:nbme-2
#2132039
  gluck - 06/19/10 09:37
 
  Nice explanation forever07, Thank you  
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* Re:nbme-2
#2132116
  forever07 - 06/19/10 11:58
 
  welcome gluck  
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* Re:nbme-2
#2132304
  chinedu - 06/19/10 17:02
 
  think is A  
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* Re:nbme-2
#2132627
  egydoc2010 - 06/20/10 10:47
 
  Agree with forever07. I just did a similar question in UW.

A.

Here is the concept...

Primary amenorrhea is managed according to age and development of 2ry sexual characteristics. If younger than 16 with well developed 2ry sexual characteristics, you delay the workup til pt is 16 as it is considered normal to not have menarche up til 16 provided that 2ry sexual characteristcs are well developed.

If younger than 16 and no 2ry sexual characteristics, then immediate workup is indicated. 1st check the breasts, if they're poorly developed or absent (indicates low estrogen), then next step is to measure FSH, if it's high, then it is 1ry ovarian failure and you order karyotyping. If it's low, then it's a central problem and you do GnRH stimulation test to differentiate a hypothalamic from pituitary problem.

I hope that helps!
 
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* Re:nbme-2
#2132634
  gluck - 06/20/10 11:09
 
  Very clear description egydoc2010 Thank you  
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* Re:nbme-2
#3388911
  pzh200707 - 06/09/20 07:26
 
  15yo w/ sexual development is enough to dx primary amenorrhea. so go for testing uterus.

I wud choose F pelvic US
 
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