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Old 03-02-2016
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Default clinical mastery pediatrics nbme form 1

a 13- year old girl is brought to the physician by her mother b/c of a 6-week history of constant abdominal pressure, breast tenderness, and weight gain. She has no history of serious illness and takes no medications. She has never had a menstrual period. She follows a normal diet and regularly participates in physical education activities at her middle school. She is at the 50th percentile for height and 75th % for weight. Vital signs are w/in normal limits. Breast and pubic hair development are tanner stage 3. Abdominal exam shows a nontender mass below the umbilicus. Which of the following is the most appropriate next step in diagnosis?

a) urinalysis
b) measurement of AFP
c) measurement of b-HCG
d) x-ray of abdomen
e) CT scan of pelvis

*picked D, got it wrong
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Old 03-03-2016
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B --- measurement of b-HCG

Primary amenorrhea is the failure of menses to occur by age 16 years, in the presence of normal growth and secondary sexual characteristics. If by age 13 menses has not occurred and the onset of puberty, such as breast development, is absent, a workup for primary amenorrhea should start.
I guess she has dysgerminoma or granulosa cell tumor. Neither of them fit perfectly there. I personally would go for B HCG.Also, seeing extremely elevated B HCG lvl excludes pregnancy as a cause of amenorrhea. However, you can easily come up with good reasons to go for CT scan first.
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Last edited by Jisb11; 03-03-2016 at 04:24 AM. Reason: ddd
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