week 3 quiz Flashcards
A 28-year-old woman presents to your clinic complaining of mood swings, abdominal bloating, and irritability that occur regularly a week before her menstrual period and resolve shortly after the onset of menstruation. She is worried that these symptoms are affecting her work and personal life. Premenstrual syndrome (PMS) is initially considered as a likely diagnosis. However, it is crucial to rule out other conditions that may present similarly.
Which of the following is the most appropriate next step in managing this patient?
Question 1 Answer
a.
Immediate referral to a psychiatrist for evaluation of possible affective disorder
b.
Arrange for the patient to start an oral contraceptive pill empirically and reassess symptoms in three months
c.
Complete a comprehensive history taking and physical examination
d.
Advise dietary modifications and reassess symptoms after two menstrual cycles
c.
Complete a comprehensive history taking and physical examination
Why are prospective questionnaires such as the Daily Record of Severity of Problems (DSRP) an important part of accurate PMS and PMDD assessment?
Question 2 Answer
a.
Administering the DRSP on the first day of menses only, using a cutoff value of 50 points, has a sensitivity of 63.4% and a specificity of 90%
b.
Patients tend to overestimate the cyclical nature of symptoms when they are in fact erratic or simply exacerbated during the luteal phase. Prospective questionnaires help to clarify this.
c.
Patients rate their symptoms through at least one menstrual cycle, which requires a significant investment of time and effort, thereby increasing psychological “buy-in” with management
d.
DRSP keeps track of how each symptom varies on waking, at noon, and in the evening, which allows finer tracking and diagnostic clarity for both PMS and PMDD
b.
Patients tend to overestimate the cyclical nature of symptoms when they are in fact erratic or simply exacerbated during the luteal phase. Prospective questionnaires help to clarify this.
A naturopathic doctor’s schedule for the day includes 4 pre-menopausal women.
AW, a 44-year-old with a doctorate-level degree who is currently employed and who has had no significant stressful life events in the past year
BE, a 25-year-old with a master’s degree who is currently unemployed and who has had no significant stressful life events in the past year
CR, a 26-year-old with a high school diploma who is currently employed and who has had no significant stressful life events in the past year
DT, a 24-year-old with a bachelor’s degree who is currently employed and who has had a significant stressful life events in the past year
Which of these women has the highest pretest probability of PMS?
Question 3 Answer
a.
DT
b.
BE
c.
AW
d.
CR
a.
DT
A 27-year-old woman presents to her naturopathic doctor with a complaint of recurrent emotional and physical symptoms that occur during the luteal phase of her menstrual cycle. For the past six months, she has documented her symptoms, which include mood swings, breast tenderness, and bloating. These symptoms resolve soon after the onset of menses and are absent in the week post-menses. She reports that these symptoms are distressing but do not significantly interfere with her daily functioning.
Based on the information provided, which of the following is the most appropriate diagnosis?
Question 4 Answer
a.
Premenstrual dysphoric disorder (PMDD)
b.
Premenstrual syndrome (PMS)
c.
Generalized anxiety disorder (GAD)
d.
Major depressive disorder (MDD)
b.
Premenstrual syndrome (PMS)
A 30-year-old woman presents to her primary care physician with complaints of mood swings, breast tenderness, and irritability that seem to worsen before her menstrual periods. She reports that these symptoms have been consistently occurring for the past six months and significantly affect her daily activities. After performing a thorough medical and psychological history and physical examination, the physician considers further evaluation for Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD).
What is the most appropriate next step in managing this patient?
Question 5 Answer
a.
Referral for psychiatric evaluation to rule out a mood disorder
b.
Prospective charting of symptoms on a calendar or diary for three menstrual cycles
c.
Arranging mammography and radiologic imaging of the pelvis
d.
Immediate commencement of hormonal therapy based on the symptoms
b.
Prospective charting of symptoms on a calendar or diary for three menstrual cycles
