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Old 11-04-2012
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Arrow Gyrus Daily Questions; Obstetrics & Gynecology #1

An 18-year-old college student presents to your office feeling depressed and irritable from 3 days prior to her menses until the day after her menses start. She reports that she frequently has to stay home from classes and is worried about its potential impact on her performance. She reports she is otherwise healthy. Menarche was at age 12, and her menses are currently regular each month. She denies significant menstrual cramping or bloating. She is sexually active with one partner, using condoms for contraception. She reports a penicillin allergy. Providing that her symptoms are prospectively documented and confirmed, what would be possible treatments for this woman?

A Ibuprofen
B Norgestimate plus ethinyl estradiol
C Calcium carbonate
D Leuprolide
E Only answer A would not be an appropriate therapy
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E Only answer A would not be an appropriate therapy

http://www.ncbi.nlm.nih.gov/pubmed/12892989
Quote:
Nonpharmacologic management with some evidence for efficacy include cognitive behavioral relaxation therapy, aerobic exercise, as well as calcium, magnesium, vitamin B(6) L-tryptophan supplementation or a complex carbohydrate drink. Pharmacologic management with at least ten randomized controlled trials to support efficacy include selective serotonin reuptake inhibitors administered daily or premenstrually and serotonergic tricyclic antidepressants. Anxiolytics and potassium sparing diuretics have demonstrated mixed results in the literature. Hormonal therapy is geared towards producing anovulation. There is good clinical evidence for GnRH analogs with addback hormonal therapy, danocrine, and estradiol implants or patches with progestin to protect the endometrium.
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B Norgestimate plus ethinyl estradiol

Could be E but I don't have a clue about Calcium carbonate.

However, the answer lies in the question as it asks "what would be possible treatments for this woman?" So, there is more than one treatment.
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feel its E..
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The answer is C Calcium carbonate

The clinical scenario presented here is describing PMS. Calcium supplementation is one therapy that may be of use to this patient and is the best answer given. Nonsteroidal anti-inflammatory agents (ibuprofen) are used to treat dysmenorrheal, not PMS. Hormonal contraception (norgestimate plus ethinyl estradiol) is indicated for PMS with primarily physical symptoms which would not be appropriate in this patient as she denies signifi cant physical symptoms.

Leuprolide would suppress menstrual cycles and is a treatment for PMS, but is associated with significant side effects and would not be a first-line therapy.

Lifestyle changes and serotonin reuptake inhibitors are other potentially
appropriate therapies for this patient.
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