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NBME 3 q

Kaplan Test Prep and Admissions (Kaptest.com)

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8 Posts

epc924
Forum Junior

Topics: 11
Posts: 60

03/13/08 - 12:19 AM

7. A 15-year-old girl is brought to the physician for a well-child examination. She is upset because her right breast is larger than the left, and she will not attend physical education classes because she is embarrassed to undress. Breast development began 2 years ago. Menarche has not yet occurred. Examination shows the right breast to be twice as large as the left; the right breast is Tanner stage 4, and the left breast is Tanner stage 3. Which of the following is the most appropriate intervention?

A ) Reassurance

B ) Psychological evaluation

C ) Estrogen therapy

D ) Progesterone therapy

E ) Operative treatment

the answer is reassurance, but i dont understand the concept behind this question. Can anyone point out to me what is the question trying to cover?

yarab99
Forum Senior
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Topics: 11
Posts: 148

03/13/08 - 12:37 AM

the girl has gynecomatia which normally occures at puperty due to hormonal changes and will resolve by it self,,,so just reassure

yarab99
Forum Senior
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Topics: 11
Posts: 148

03/13/08 - 12:38 AM

hope that helps

Tiff
Forum Guru

Topics: 49
Posts: 500

03/13/08 - 01:00 PM

For this girl thelarche started 2 years ago when she was 13. That's normal. However this girl has delayed menarche since she's over 14 years of age. Asymmetry in the absence of nodularity and pathology can also be a normal condition that can later be surgically corrected, however it's unnecessary. So patient just needs reassurance. I believe the question wants to emphasize that juvenile assymetry can occur. It can be due to number of issues. Could be congenital or even hereditary. In this particular case I believe what they are trying to cover is to acknowledge that amastia (underdeveloped breasts) can occur with delayed menarche. If this is a case of juvenile hypertrophy, that usually will regress over time.

Just wanted to further clarify that this is not gynecomastia as that is a condition associtated with males not females.

yarab99
Forum Senior
avatar

Topics: 11
Posts: 148

03/13/08 - 01:55 PM

ya right,,,didnt find the righy term..sorry

epc924
Forum Junior

Topics: 11
Posts: 60

03/28/08 - 05:33 PM

Tiff wrote:
For this girl thelarche started 2 years ago when she was 13. That's normal. However this girl has delayed menarche since she's over 14 years of age. Asymmetry in the absence of nodularity and pathology can also be a normal condition that can later be surgically corrected, however it's unnecessary. So patient just needs reassurance. I believe the question wants to emphasize that juvenile assymetry can occur. It can be due to number of issues. Could be congenital or even hereditary. In this particular case I believe what they are trying to cover is to acknowledge that amastia (underdeveloped breasts) can occur with delayed menarche. If this is a case of juvenile hypertrophy, that usually will regress over time.

Just wanted to further clarify that this is not gynecomastia as that is a condition associtated with males not females.

thank you very much Tiff nod

Interferon18
Forum Newbie

Topics: 1
Posts: 22

04/09/08 - 03:20 AM

hi since thelarche predceds menarche in 95% the answer here should be re-assurance coz menarche can as delayed as 15yrs(somebooks say even 16yrs)...and i think since she is undergoing so much of hormonal changes she needs to assured somebody apart from her family and friends and what better person than a doctor in those so difficult teenage years when kids become so self conscious.
hope i made some sense here

kalyansarma
Forum Newbie

Topics: 0
Posts: 7

04/19/08 - 04:14 AM

in all females...it has been exprimentally proved dat the 2 breast r of unequal sizes,,,,it is due 2 diff in estrogen sensitivity.......hence reassurance is da ans...

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