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Old 06-25-2012
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Question Primary Ammenorrhea with normal pelvic ultrasound!

A 17-year-old girl comes into the outpatient clinic concerned that she has not yet started her menses. She is the only one out of her group of girlsfriends who has not and she is concerned that something is wrong. During questioning, she reports that both her mother and her sister menstruated at age 13. She denies taking any medications, doing rigorous exercise, or dieting. She is at the 75th percentile for her age in height and weight. On examination, she has Tanner 4 breast and pubic hair development. A pelvic ultrasound reveals normal female anatomy. Which of the following is the most likely diagnosis?


A. Imperforate hymen
B. Physiologic pubertal delay
C. Prolactinoma
D. Testicular feminization syndrome
E. Turnerís syndrome
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Old 06-25-2012
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She is 17 and has appropriate breast and pubic hair development.

She has normal female anatomy and she has appropriate height for her age, so it can't be Turner's.
Normal female anatomy also rules out TFS.
Nothing in the questions points toward Prolactinoma.
If she has appropriate pubic hair development, it is not physiological pubertal delay.

I think it is A - IMPERFORATE HYMEN.
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Quote:
Originally Posted by Merrily View Post
She is 17 and has appropriate breast and pubic hair development.

She has normal female anatomy and she has appropriate height for her age, so it can't be Turner's.
Normal female anatomy also rules out TFS.
Nothing in the questions points toward Prolactinoma.
If she has appropriate pubic hair development, it is not physiological pubertal delay.

I think it is A - IMPERFORATE HYMEN.
ans is physiological pubertal delay
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Old 06-25-2012
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There is not a physiologic pubertal delay according to kaplan lecture notes 2011 and elmar p sakala
The answer is idiopathic pubertal delay
I would have picked that option eventho is wrong because by saying anatomy is normal they should've discarded imperforate hymen
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Old 06-25-2012
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Quote:
Originally Posted by XpaezX View Post
There is not a physiologic pubertal delay according to kaplan lecture notes 2011 and elmar p sakala
The answer is idiopathic pubertal delay
I would have picked that option eventho is wrong because by saying anatomy is normal they should've discarded imperforate hymen
I dont think you can diagnose imperforate hymen via pelvic ultrasound. The ultrasound gave us the information that the pt has uterus.
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Originally Posted by tyagee View Post
On examination, she has Tanner 4 breast and pubic hair development. A pelvic ultrasound reveals normal female anatomy
The clue here is that the pt has only tanner stage 4 breast at age17. so there is an obvious delay.
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Old 06-26-2012
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Quote:
Originally Posted by neoeinstein View Post
I dont think you can diagnose imperforate hymen via pelvic ultrasound. The ultrasound gave us the information that the pt has uterus.

The clue here is that the pt has only tanner stage 4 breast at age17. so there is an obvious delay.
Nope, it can be seen on physical examination, and ultrasound will sometimes show accumulation of blood inside the vagina and lower uterus, in kaplan videos sakalashows an ultrasound with accumulation of blood
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Old 06-28-2012
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A. Imperforate hymen
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Old 06-29-2012
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She is 17 but has tanner stage of a 15yr old............ so it is Physiologic pubertal delay..................am I missing something here ?

Quote:
In the Tanner study, the mean age of Tanner Stage 4 was 13.1 years.
Quote:
Menarche
Menarche, or the first menstrual period, is not part of the Tanner staging system. You need a certain
amount of estrogen to menstruate, but it can happen at Tanner stage 2, 3, 4 or even 5. The response
of the vaginal mucosa and the vaginal lining to estrogen and progesterone is different from what is
happening in the breast.
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Endocrinology-, Pediatrics-, Step-2-Questions

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