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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?
|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=.
|Explanation='''Educational Objective:'''
 
Secondary [[amenorrhea]] could be caused due stress that alter hypophthalmic pituitary axis.  
'''Educational Objective:'''
|AnswerA=Abdominal US
Avascualr necrosis should be considered in patients with multiple attacks of sickle cell crisis.
|AnswerA=Femoral fracture
|AnswerAExp='''Incorrect'''-[[]]
|AnswerAExp='''Incorrect'''-[[]]
|AnswerB=Joint effusion from septic arthritis
|AnswerB=Endometrial biopsy
|AnswerBExp='''Incorrect'''-[[]].
|AnswerBExp='''Incorrect'''-[[]].
|AnswerC=Avascular necrosis
|AnswerC=TSH
|AnswerCExp='''Correct'''-[[]]
|AnswerCExp='''Incorrect'''-[[]]
|AnswerD=LH
|AnswerDExp='''Incorrect'''-[[]].
|AnswerDExp='''Incorrect'''-[[]].
|AnswerE=Osteomyelitis caused by Staphylococcus
|AnswerE=Reassurance
|AnswerEExp='''Incorrect'''-[[]]
|AnswerEExp='''Correct'''-[[]]
|RightAnswer=C
|RightAnswer=C
|WBRKeyword=Drug induced myopathy, Steroid induced myopathy
|WBRKeyword=Secondary Amenorrhea, stress induced amenorrhea, Hypothalamic pituitary axis
|Approved=No
|Approved=No
}}
}}

Revision as of 01:16, 27 January 2014

 
Author [[PageAuthor::Ahmed Zaghw, M.D. [1]]]
Exam Type ExamType::
Main Category
Sub Category
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-[[]]]]
Answer B AnswerB::Endometrial biopsy
Answer B Explanation [[AnswerBExp::Incorrect-[[]].]]
Answer C AnswerC::TSH
Answer C Explanation [[AnswerCExp::Incorrect-[[]]]]
Answer D AnswerD::LH
Answer D Explanation [[AnswerDExp::Incorrect-[[]].]]
Answer E AnswerE::Reassurance
Answer E Explanation [[AnswerEExp::Correct-[[]]]]
Right Answer RightAnswer::C
Explanation [[Explanation::Educational Objective:

Secondary amenorrhea could be caused due stress that alter hypophthalmic pituitary axis.
Educational Objective:
References: ]]

Approved Approved::No
Keyword WBRKeyword::Secondary Amenorrhea, WBRKeyword::stress induced amenorrhea, WBRKeyword::Hypothalamic pituitary axis
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