These are the blue sheet, physical exam, diagnostic studies and differential diagnosis needed for a menstrual irregularity/amenorrhea case in the USMLE Step 2 CS exam:
BLUE SHEET Amenorrhea/Menstrual irregularity:
MNEMONIC Menstrual irregularities/amenorrhea:
“FLAG HI V”: When missing a period that’s a “FLAG” that we will say “HI” to a new “Visitor” at home. Please, remember that pregnancy is the most likely diagnosis in amenorrhea.
F: Fat pill (to lose weight use).
L: Libido status
A: Anorexia (eating behaviors)
G: Galactorrhea
H: Hot flashes
I: Insomnia
V: Visual changes
PHYSICAL EXAMINATION
1. HEENT:
PERRLA, EOM, visual fields by confrontation.
Neck:
Thyroid examination.
2. Lungs:
Auscultation.
3. Heart:
Auscultation.
4. Abdominal:
Inspection
Auscultation
Palpation
Percussion
5. Ext:
Inspection
6: Neurologic:
DTR’s (since thyroid problems are in the differential).
POSSIBLE DIAGNOSTIC STUDIES:
- Pelvic and breast examinations.
- Urine hCG.
- CBC, electrolytes, glucose.
- BUN/Cr.
- Prolactin, TSH, FSH, LH.
- Testosterone and DHEA-S (Polycystic ovary syndrome-PCOS).
- AST, ALT, bilirubins, alkaline phosphatase,
- MRI of the brain.
- Hysteroscopy.
DIFFERENTIAL DIAGNOSIS:
- Pregnancy.
- Hyperprolactinemia.
- Pituitary tumors.
- Thyroid problems: both hyper and hypothyroid cause menstrual irregularities.
- Anorexia and other eating disorders.
- Functional hypothalamic amenorrhea.
- PCOS
- Premature ovarian failure.
- Asherman’s syndrome.
- Kallman’s syndrome
I hope this information was helpful for you, please leave your comments below and I will try to answer as soon as possible. Start practicing early the mnemonics for easier memorization. Good luck with your studies.
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