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21. A 12-year-old girl is brought to the physician
by her mother
because of heavy vaginal bleeding since her first
menstrual period began 1
week ago. She has to change sanitary pads every 2
hours, and her
mother is concerned that this is not normal. Her
blood pressure is 80/60 mm
Hg, and pulse is 110/min. Breast and axillary and
pubic hair
development are Tanner stage 4. Pelvic examination
shows normal external
genitalia, a small normal-appearing cervix, and a
small uterus. Her
hemoglobin level is 7 g/dL

A
) Bacterial vaginosis

B
) Precocious puberty

C
) Urinary tract infection

D
) Vaginal foreign body

E
) Vaginal laceration

F
) von Willebrand's disease

ff??

Her Hb is only 7 , she is also anemic so it cant be Von Willebrands right?

Unless she has been bleeding for 1 week and now she has also become amenic. Maybe you are right F . All the other choices don't make much sense.

Menorrhagia!!
F!!

k, I am starting to appreciate that she might have a bleeding disorder and vWf deficiency...

But can someone please explain to me why its a normal finding to have Tanner Stage 4 in a 12 year old. From reading the notes I understood that to be pendulous breasts of an adult woman so I chose Precocious Puberty on the test.
If anyone can explain this Tanner staging to me that would be great. thx!