12-02-2010, 01:23 PM
A 15-year-old girl is brought to the office for the first time by her mother, who has been your patient for many years. The mother is concerned because her daughter, who had menarche at age 11 years, has not had a period in the past 6 months. Both mother and daughter have kept a record of the girl's periods. The first three periods were irregularly spaced and not painful. Subsequent periods were regularly spaced and were accompanied by severe cramping on the first day. The cramping subsided 1 year ago. The mother insists that you interview her and her daughter together. She says that her daughter is not sexually active. She tells you that her daughter gets straight A grades and that she is very active in sports. The girl is also a cheerleader and is taking a night course for college credit at the local community college through the school's gifted child program. The mother tells you that her daughter has a good appetite for healthy food and does not eat junk food. She asks you what is causing her daughter's amenorrhea. Item 1 of 2 27. Which of the following is the most appropriate initial response? A) "In young women, missing a few periods is not unusual, and we should wait a while longer before becoming concerned." B) "It is a well-known fact that the most likely cause of amenorrhea in young women is pregnancy. How can you be certain she has not been sexually active?" [C) "Many things can cause missed periods. After I examine your daughter, I may be able to provide more insight into the problem."] D) "Over-involvement in some athletic activities can cause menstrual periods to cease." E) "Your daughter is involved in a lot of activities and may be under stress. That can certainly be a factor in causing cessation of periods." Item 2 of 2 28. After responding to the mother's question, you ask the mother to wait outside while you speak privately with the girl and do a physical examination. No additional information is obtained. Vital signs are: temperature 37.0°C (98.6°F), pulse 110/min and blood pressure 90/50 mm Hg. Height is 165 cm (5ft 5 in) and weight is 49 kg (105 lb). Physical examination shows some