A 15-Year-Old Girl Is Brought to the Office Due to Prolonged

question 330

Multiple Choice

A 15-year-old girl is brought to the office due to prolonged, irregular menstrual periods.  Menses occur at 2- to 4-month intervals and last for 7-10 days with heavy bleeding and passage of large clots.  The patient's menstrual cycles are nonpainful and she has no associated dizziness, fatigue, palpitations, or abnormal vaginal discharge.  Menarche was at age 14 and her last menstrual period was a month ago.  She has no other chronic medical conditions or previous surgeries.  The patient has never been sexually active.  Blood pressure is 110/70 mm Hg and pulse is 72/min.  Height and weight are at the 40th and 56th percentiles, respectively.  The thyroid is without nodules.  The skin has no discoloration or ecchymosis.  Breast and pubic hair development are Tanner stage V.  External pelvic examination shows no lacerations, lesions, discharge, or bleeding.  The hymenal membrane is intact.  Hemoglobin is 10.4 g/dL.  PT and aPTT are normal.  Which of the following is the best next step in management of this patient?

• A)Order pelvic MRI
• B)Perform cervical nucleic acid amplification testing
• C)Perform endometrial biopsy
• D)Perform hysteroscopy
• E)Place copper-containing intrauterine device
• F)Start oral progesterone therapy

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Definitions:

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