WBR1036: Difference between revisions

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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{AZ}}
|QuestionAuthor= {{AZ}}
|Prompt=A 18-year-old African american male comes to the office for the evaluation of pain in his right hip that started 7 weeks ago. The pain has gradually progressed, and now it limits his daily activities. He has sickle cell disease and was hospitalized 4 months ago due to a painful crisis that was successfully treated with hydration, oxygen,  and  analgesics. His temperature is 37.4C (99F), blood pressure is 120/90 mmHg, pulse is 90/min, and respirations are 14/min. Physical examination reveals no local tenderness, but there is restriction of abduction and internal rotation of the hip. What is the most likely diagnosis?
|ExamType=USMLE Step 2 CK
|Explanation=.
|MainCategory=Internal medicine, OB/GYN
 
|SubCategory=Endocrine, Head and Neck, Obstetrics & Gynecology
'''Educational Objective:'''
|MainCategory=Internal medicine, OB/GYN
Avascualr necrosis should be considered in patients with multiple attacks of sickle cell crisis.
|SubCategory=Endocrine, Head and Neck, Obstetrics & Gynecology
|AnswerA=Femoral fracture
|MainCategory=Internal medicine, OB/GYN
|AnswerAExp='''Incorrect'''-[[]]
|SubCategory=Endocrine, Head and Neck, Obstetrics & Gynecology
|AnswerB=Joint effusion from septic arthritis
|MainCategory=Internal medicine, OB/GYN
|AnswerBExp='''Incorrect'''-[[]].
|MainCategory=Internal medicine, OB/GYN
|AnswerC=Avascular necrosis
|SubCategory=Endocrine, Head and Neck, Obstetrics & Gynecology
|AnswerCExp='''Correct'''-[[]]
|MainCategory=Internal medicine, OB/GYN
|AnswerDExp='''Incorrect'''-[[]].
|SubCategory=Endocrine, Head and Neck, Obstetrics & Gynecology
|AnswerE=Osteomyelitis caused by Staphylococcus
|MainCategory=Internal medicine, OB/GYN
|AnswerEExp='''Incorrect'''-[[]]
|SubCategory=Endocrine, Head and Neck, Obstetrics & Gynecology
|MainCategory=Internal medicine, OB/GYN
|SubCategory=Endocrine, Head and Neck, Obstetrics & Gynecology
|MainCategory=Internal medicine, OB/GYN
|MainCategory=Internal medicine, OB/GYN
|SubCategory=Endocrine, Head and Neck, Obstetrics & Gynecology
|Prompt=A 16 year old girl comes to the clinic, complaining of irregular vaginal spotting for the last 2 months. She has never had any bleeding between periods in the past. She has been taking oral contraceptive pills for the last two months and occasional pain killers for her ankle strain. She is a professional tennis player and trains daily for more than 4 hours. She reports that she has been stressed for the last month trying to catch up with her schedule for the next national championship. The pelvic examination is unremarkable. Her lab tests does not reveal any abnormality. Her pregnancy test is negative. What is the best next step?
|Explanation=The first step in a patient with secondary amenorrhea is to rule out common situations as pregnancy. Given her strenuous life style, competitive sport training and negative pregnancy test increase the probability of hypothalamic pituitary axis (HPA).
Reassurance and life style modification is the best approach for HPA disorder.
Secondary [[amenorhea]] could be caused due stress that alter hypophthalmic pituitary axis.
|AnswerA=Abdominal US
|AnswerAExp='''Incorrect'''- Abdominal ultrasound is not needed to investigate HPA disorder
|AnswerB=Endometrial biopsy
|AnswerBExp='''Incorrect'''- [[Endometrial biopsy]] is only needed to assess the luteal phase and response of the endometrium to the progestrone.
|AnswerC=TSH
|AnswerCExp='''Incorrect'''- TSH is not needed to assess HPA disorder.
|AnswerD=LH
|AnswerDExp='''Incorrect'''- LH is not needed to assess HPA disorder
|AnswerE=Reassurance
|AnswerEExp='''Correct'''-Reassurance and follow up is the best approach for HPA disorder.
|EducationalObjectives=Secondary [[amenorrhea]] could be caused due stress that alter hypophthalmic pituitary axis.
|References=First Aid USMLE 2 CK
|RightAnswer=C
|RightAnswer=C
|WBRKeyword=Drug induced myopathy, Steroid induced myopathy
|WBRKeyword=Secondary Amenorrhea, stress induced amenorrhea, Hypothalamic pituitary axis
|Approved=No
|Approved=No
}}
}}

Latest revision as of 02:26, 28 October 2020
Author [[PageAuthor::Ahmed Zaghw, M.D. [1]]]
Exam Type ExamType::USMLE Step 2 CK
Main Category MainCategory::Internal medicine, MainCategory::OB/GYN
Sub Category SubCategory::Endocrine, SubCategory::Head and Neck, SubCategory::Obstetrics & Gynecology
Prompt [[Prompt::A 16 year old girl comes to the clinic, complaining of irregular vaginal spotting for the last 2 months. She has never had any bleeding between periods in the past. She has been taking oral contraceptive pills for the last two months and occasional pain killers for her ankle strain. She is a professional tennis player and trains daily for more than 4 hours. She reports that she has been stressed for the last month trying to catch up with her schedule for the next national championship. The pelvic examination is unremarkable. Her lab tests does not reveal any abnormality. Her pregnancy test is negative. What is the best next step?]]
Answer A AnswerA::Abdominal US
Answer A Explanation AnswerAExp::'''Incorrect'''- Abdominal ultrasound is not needed to investigate HPA disorder
Answer B AnswerB::Endometrial biopsy
Answer B Explanation [[AnswerBExp::Incorrect- Endometrial biopsy is only needed to assess the luteal phase and response of the endometrium to the progestrone.]]
Answer C AnswerC::TSH
Answer C Explanation AnswerCExp::'''Incorrect'''- TSH is not needed to assess HPA disorder.
Answer D AnswerD::LH
Answer D Explanation AnswerDExp::'''Incorrect'''- LH is not needed to assess HPA disorder
Answer E AnswerE::Reassurance
Answer E Explanation AnswerEExp::'''Correct'''-Reassurance and follow up is the best approach for HPA disorder.
Right Answer RightAnswer::C
Explanation [[Explanation::The first step in a patient with secondary amenorrhea is to rule out common situations as pregnancy. Given her strenuous life style, competitive sport training and negative pregnancy test increase the probability of hypothalamic pituitary axis (HPA).

Reassurance and life style modification is the best approach for HPA disorder. Secondary amenorhea could be caused due stress that alter hypophthalmic pituitary axis.
Educational Objective: Secondary amenorrhea could be caused due stress that alter hypophthalmic pituitary axis.
References: First Aid USMLE 2 CK]]

Approved Approved::No
Keyword WBRKeyword::Secondary Amenorrhea, WBRKeyword::stress induced amenorrhea, WBRKeyword::Hypothalamic pituitary axis
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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