nbme 1,Block3,40 - gainer84

[ArchivalUser]

40. A 13-year-old girl is brought for a well-child examination. Menses have occurred every other
month since menarche 10 months ago. Her last menstrual period was 1 week ago. She is not
sexually active. Sexual development is Tanner stage 3. Examination shows no abnormalities. Which
of the following is the most appropriate next step in management?
A
) Discussion of pregnancy prevention
B
) Measurement of serum luteinizing and follicle-stimulating hormone levels
C
) Urine β-hCG test
D
) Pelvic examination
E
) Estrogen therapy
F
) Diagnostic laparoscopy

[ArchivalUser]

aaaaa

[ArchivalUser]

The answer is B????????????I don kno hw?

[ArchivalUser]

AA

[ArchivalUser]

its D.She has irregular cycles which could be physiological d/t anovulation

why u guys wanna do pregnancy counselling when she is not sexually active.

Physical examination comes b4 any test and tX

[ArchivalUser]

@aaz,remember that after menarche the hypothalamo-pituitary-ovarian axis is still immature so it will take about 1-2yrs after menarche to have an established pattern of menses.Having irregular menses at this age is no surprise.Pls correct me if i am wrong.

[ArchivalUser]

I agree with mos,,,,,,,,,,,,,,,,,,,,,She ia an adolescent,,,,and contraceptive concelling is necessary

[ArchivalUser]

yes ur absolutely right ..thats y i said physiologican anovulation.

BUt Acc to kaplan Rule...Physical exam come after history b4 any lab work which is here pelvic exam,

Discussion of pregnancy prevention is a part of counselling which shd be done at the end of the pt's visit...Pt is not sexually active and even though if she is active it she done at the end.

[ArchivalUser]

U dont do counselling before physical exam in any case.

[ArchivalUser]

@ aaz is says that examination was normal.I think the q is trying to hint us on anticipatory guidance in adolescents.