Problem 9: Natasha is an 18 YO high school senior and aspiring ballet dancer. An
ID: 3515506 • Letter: P
Question
Problem 9: Natasha is an 18 YO high school senior and aspiring ballet dancer. An opportunity at the Houston ballet gives her the opportunity to move from the chorus to principal dancer. However she is worried about being sideline by persistent lower leg pain. She is 5’ 9” tall and weighs 121 pound. She has excellent muscle tone and 8% body fat by skin fold measurement. The dance company physician x-rays the leg and finds a hairline fracture in the right tibia. DEXA scans on both the right leg and arm suggest significant bone mineral loss in both locations. A urine analysis finds Na, K, Ca, PO4 and glucose all normal. The interview indicates she is focused and busy but well adjusted. Although unconcerned, she relates a history of irregular periods and an absence of menses for six months. Physical exam suggest a lean fit you woman with little breast development and sparse pubic hair.
1. Natasha likely suffers from:
A. Exercise amenorrhea.
B. An occupational fall.
C. Hypocortisolism.
D. Vitamin D abuse.
E. Hypoparathyroidism.
2. A thorough blood work up would find:
A. Elevated hCG.
B. Low estrdiol.
C. Elevated PTH.
D. High Vitamin D.
E. Hyperthyroidism.
3. After the fracture heals what is the recommended therapy other than quitting the ballet:
A. Yoga for flexibility.
B. Lower body strength training.
C. Combination estrogen/progestin contraception.
D. A slow release progestin implant.
E. Take a regular aerobics class.
4. What secondary recommendation should be made:
A. Take a Calcium Supplement.
B. Take a Vitamin D supplement.
C. Eat a well balanced diet.
D. Decompress, reduce stress regular sleep schedule.
E. All of the above.
Explanation / Answer
1.A exercise amenorrhea
2.E.Hyperthyroidism
3.C.combination estrogen/progestin contraception
4.E.all of abovve.
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