Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
A 28-year-old white female consults you with a complaint of irregular heavy menstrual periods. Her general physical examination, pelvic examination, and Papanicolaou test are normal and she has a negative pregnancy test. A CBC and chemistry profile are also normal.
The next step in her workup should be
endometrial aspiration for tissue sampling
dilatation and curettage to diagnose and treat uterine polyps
pelvic ultrasound
administration of estrogen to enhance the development of proliferative endometrium
cyclic administration of progesterone for 3 months with subsequent reevaluation
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
administration of estrogen to enhance teh development of proliferative endometrium to stabilize the endometrium
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
cyclic administration of progesterone for 3 months with subsequent reevaluation
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
why not pelvic USG? if its an emergency and the px is unstable then maybe D (estrogen). If you need to continue work-up then the next thing u should rule out are fibroids/myoma hence C. Endometrial sampling would be done if u suspect ca, but the px is too young (<35)and there are no other risk factors.
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
administration of estrogen to enhance the development of proliferative endometrium
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
usually they give combine OCPs for DUB
If estrogen only she'll have risk of endometrial & breast cancer
So i choose E
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
Sorry, I changed my mind after checking on CMDT.
Agree with Rocks, the choice should be E. Progestrin is DOC for DUB because the endometrium proliferates without progesterone stimulation and no withdrawal bleeding (no ovulation, no progesterone). hence, a few cycles of progestrin is needed for most DUB pts. Combined OCP is equally acceptable. For severe uterine bleeding, conjugated estrogen is DOC but this is not the case for this one. If the above treatment does not work, further work up including USG, endometrium biopsy, endocervical curettage, hysteroscopy etc are required.
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
guys why not pelvic ultrasound.stem of question asked wats the next step in her work up NOT wats
next step in management .
so i think ultrsound will be the ans
