USMLE 29

A mother of a 4 year old girl brings her daughter to see you because the girl developed breasts 6 months ago. The girl has had no vaginal bleeding, and there is no pubic hair. She takes no medication.

1-Which of the following is the most appropriate next diagnostic step?

A) Ultrasound of the pelvic.

B) pelvic examination under anaesthesia.

C) CT scan of her head.

D) serum estradiol concentration.

E) serum FSH concentration.

2- The tests you ordered are normal for a prepubertal girl.

Which of the following is the most likely diagnosis?

A) Ingestion of mother's COCs.

B) A granulosa cell tumor.

C) 21 hydroxylase deficiency.

D) Polycyctic ovary syndrome.

E) Premature thelarche.

USMLE 28

A 30 year-old woman has used COCs for 5 years with no problem.However, she just read an article about complications of COCs and asks you about the risks and hazards of taking COCs.

You will tell her :

A) The risk of developing endometrial carcinoma is decreased.

B) The risk of developing ovarian cancer is increased.

C) The risk of developing PID in increased.

D) The risk of ectopic pregnancy is increased.

E) The risk of bearing a child with major congenital anomalies is increased if taken while pregnancy.

Medical instrument 17

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USMLE 24

A 19 year old high school senior complains of feeling (fat & ugly) despite being extremely thin.She takes small amounts of food at meals and occasionally gags herself to induce vomiting after meals.

Which of the following is commonly associated with this disorder?

a)Metrorrhagia.

b)Menorrhagia.

c)Loss of body hair.

d)Bradycardia.

e)Thrombocytopenia.

Medical Instrument 9

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USMLE 21

A 17 year old girl presents with a 2 day history of lower abdominal discomfort, burn in micturition & increased frequency of urination. She had her first sexual intercourse last week. Her vital signs are stable.

Examination shows supra-pubic tenderness. Urinalysis shows +ve esterase, 50+ WBC and many bacteria.

Which of the following is the most likely mechanism responsible for her clinical condition?

A- Hematogenous spread of infection.

B- Lymphatic spread of infection.

C- Sexual transmission.

D- Poor genital hygiene.

E- Ascending infection.