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A 25 y.o. woman has not had her peiriod for the last 8 months. She is 5'2" and weighs 90 pounds. A urine pregnancy test is negative. She states that she has been trying to lose weight for her upcoming wedding. You order a battery of tests and give the patient an intramuscular injection of progesterone. Ten days later the patient return to your office and reports that she had no withdrawal bleeding. Laboratory tests reveal the following: serum prolactin is normal, serum FSH and LH are low, serum TSH is normal, serum estradiol is low, and serum cortisol and growth hormone are increased. Based on these findings, you strongly suspect the patient has...

A) Primary ovarian disease
B) Hypopituitarism
C) Secondary hypothyroidism
D) Weight loss syndrome
E) Cushing's syndrome

Follicular hyperkeratosis, night blindness, and a hemorrhagic diathesis are expected in a patient...
A) with Cystic Fibrosis
B) with Scurvy
C) with Hypothyroidism
D) who is a pure vegan
E) who is bulimic

Which of the signs or symptoms characterize a fat soluble rather than a water soluble vitamin deficiency?
a) perifollicular hemorrhage
b) bone, pain and tetany
c) peripheral neuropathy
d) ophthalmoplegia, confusion and ataxia
e) hyperpigmentation in sun exposed areas


Paid da cost 2 be da bo$$
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1) ARE YOU SURE YOU COPIED THE QUESTION CORRECTLY?. The elevated cortisol is consistent with starvation induced stress, as is the Leptin induced disruption of GnRH pulsations(low FSH/LH) resulting in low E2. While at first glance the answer seems an obvious D, the GH levels are elevated which contrasts with what should be expected(low due to the energy conservative effect of decreased circulating leptin):
Body Fat, Leptin, and Hypothalamic Amenorrhea. NEJM. 351;10:959-962

The negative result of the progesterone challenge, the low FSH, and the normal prolactin levels all combined indicate the problem is not the result of abnormal pituitary secretions. Cross out B. A good primer on the progesterone challenge:

The progesterone challenge also indicates the uterus is not being primed with estrogen...cross out A

The patient is not overweight...cross out C & E.

2) This is actually a good question requiring two-step reasoning. First you are required to know what these terms mean...I will leave that to you. Second, you must know they are associated with fat-soluble vitamin, which of the following would lead to a deficiency of fat-soluble vitamins? ;)

3)This question could alternatively ask, "You have recently set up a clinic in Siberia because you are nocturnal and can accomplish twice as much work due to the continual darkness. Which of the following would you expect to see in a pt presenting to your clinic during the winter?"

Here is a hint...what is Vit D responsible for?


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These qns were sent to me by a friend, no answers given and i checked the qn.. its same as i copied here.

Thanks for ur input...

My answers are


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