13 year old adolescent girl who presents with cyclic pelvic pain.

She has never had a

menstrual cycle. She denies any history of intercourse. She is afebrile and her vital sign are
stable. On physical examination, she has age appropriate breast and pubic hair
development and normal external genetalia. However, you are unable to locate a vaginal
introitus. Instead, there is a tense bulge where the introitus would be expected. You obtain
a transabdominal ultrasound, which reveal hematocolpos and hematometra

1. What is the most likely diagnosis?

a. Transverse vaginal septum
b. Longitudinal vaginal septum
c. Imperforate hymen
d. Vaginal atresia (MRKH)
e. Bicornuate uterus

2. What symptoms that support this include

a. Absent uterus on ultrasound
b. Not age appropriate of sex secunder
c. Anemia
d. Increasing abdominal girth
e. Had menstrual cycle

3. Appropriate treatment option is?

a. Incision and drainage
b. High dose steroid application
c. Topical estrogen application
d. Excision of the extra tissue and evacuation of accumulated material
e. Creation of neovagina when ready to intercourse

An 18 year old young woman presents to you with complaint of amenorrhea. She notes that
she has never had a menstrual period, but that she had mild cyclic abdominal bloating. She is
sexually active, but she complaint painful sexual intercourse. Her past medical and surgical
history is unremarkable. On physical examination, you note normal appearing axillary and pubic
hair. Her breast development is normal. pelvic examination reveals normal appearing external
genitalia, and shortened vaginal ending in a blind pouch.

1. Which of the following test would be your first step in determining the diagnosis
a. Karyotype
b. Pelvic ultrasound
 c. Serum FSH
d. Serum FSH, E2
e. Diagnostic laparoscopy
2. From further examination it was found that uterus cannot be visualized, both ovary
were normal. what is the most likely diagnosis
a. Imperforate hymen
b. Transverse vaginal septum
c. Mullerian agenesis
d. Androgen insensitivity syndrome
e. Gonadal dysgenesis

3. Which additional organ system should you be evaluating in patient with this disorder
a. Pancreas and duodenum
b. Cerebral circulation
c. Olfactory system
d. Renal and urinary collecting system
e. Distal gastrointestinal tract