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You are seeing a 34-year-old Asian female who previously had…

You are seeing a 34-year-old Asian female who previously had normal, monthly periods but has not had a period for the last 4 months. She also complains of headaches for the 3-4 months. You notice that her left arm is in a sling. She tells you that she had a minor car accident. She was making a right turn out of a parking lot and for some reason she did not see the car coming from her left and just pulled out in front of it. Fortunately, neither she nor the passengers in the other car were significantly injured. She did injure her shoulder which is why she is wearing the sling. She is sexually active. Her partner uses a condom for birth control. She denies palpitations, heat or cold intolerance, or difficulty sleeping. She does complain of some breast tenderness. This is constant and does not come and go. She has not noticed any change in her complexion or any excess hair growth. She is a G0P0AB0 female. There is no history of any surgeries or uterine procedures such as a Dilation and curettage (D&C).    Physical exam is significant for diminished peripheral vision with decreased perception in both lateral visual fields. Otherwise, her physical exam is completely normal. No thyroid enlargement, nodularity or tenderness. Pelvic exam is normal with no abnormal cervical discharge. No enlargment of uterus or ovarian masses. pregnancy test is negative TSH is 3 mU/L (normal is 0.5-5 mU/L) Prolactin is 35 ng/ml (normal is less than 20) CBS, blood chemistries including glucose are normal Urinalysis is normal, no blood or protein are present Pelvic ultrasound shows normal uterus and ovaries.  Brain MRI shows enlarged pituitary gland with dense central mass. This scenario addresses 4 different possible causes of amenorrhea. List the four causes and what symptoms/signs and lab findings (or lack of symptoms/signs) support or rule out each of these causes.

You are seeing a 55-year-old man who is relatively healthy b…

You are seeing a 55-year-old man who is relatively healthy but complains of the symptoms of benign prostatic hyperplasia. His physical exam is normal except for a slightly enlarged prostate noted on digital rectal exam. There is no tenderness or nodularity to the prostate. His PSA is normal for his age and ethnicity.  His initial screening questionnaire indicates he has mild to moderate symptoms. What is the next question you should ask to determine whether or not you should initiate medical therapy for his symptoms?