A 14-Year-Old Girl Is Brought to the Office for a Routine

question 602

Multiple Choice

A 14-year-old girl is brought to the office for a routine physical examination.  The patient is starting high school and is going to be on the school's cross-country team.  She has no concerns today.  She is healthy and takes no daily medications.  Family history is significant for hypertension in her mother.  The patient has not undergone menarche and is not sexually active.  Height and weight are at the 25th percentile for age.  Physical examination shows sexual maturity rating (Tanner) stage 1 breast development.  The abdomen is soft, nontender, and nondistended.  A small, nonreducible mass is palpated in the left inguinal area.  On pelvic examination, the external genitalia appear normal, and there is no pubic hair.  The vagina ends in a blind pouch.  Sonogram confirms the absence of a uterus, cervix, and ovaries.  Karyotype is 46,XY.  Which of the following is the best next step in management of this patient?

• A)Elective gonadectomy procedure
• B)Estrogen therapy
• C)Growth hormone therapy
• D)Hymenectomy
• E)Low-dose corticosteroid therapy
• F)Reassurance and no further treatment

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Definitions:

Super-Ego

In psychoanalytic theory, the part of the personality that acts as a moral center, guiding behavior according to learned societal standards.

Psychosexual Stages

A theory by Freud describing how personality develops through five stages from infancy to adulthood, centered on sexual pleasure.

Response Tendencies

The likelihood of a person to react in a specific manner when presented with a particular stimulus.

Stimulus Situations

Specific environmental conditions or events that elicit responses from individuals or organisms.