This page is dedicated to organizing various examples of standardized exam questions whose answer is imperforate hymen. While this may seem a odd practice, it is useful to see multiple examples of how imperforate hymen will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
Question # 1
A 16 year old girl comes to the clinic with her mother because she has never had a menstrual period. She also has begun to notice some slight lower abdominal pain during the past 6 months. She has no remarkable past medical history, and is not taking any medications. Her BMI is 21 kg/m². Her breast development is Tanner stage 4. Her physical exam shows coarse pubic and axillary hair. Pelvic exam reveals an external genitalia that is unremarkable. Her vaginal canal can not be visualized during the exam. Rectal examination reveals an anterior central mass that is tender. What is the most likely explanation for these findings?
Question # 2
A 16 year old girl is brought to the physician because of experiencing severe abdominal pain for the past 1 week. During the past year she has had 10 episodes of cramps, each episode lasting 3 to 5 days. She has had no remarkable past medical history, and does not take any medications. She denies every having a menstrual period. She is sexually active with one male parter, but they do not use contraception. She is in the 80th percentile for both her height and weight. Her temperature is 100°F, pulse is 115/min, respiration’s are 15/min, and blood pressure is 90/55 mm Hg. Breast and genital development is Tanner stage 5. Abdominal examination shows moderate tenderness. A mass is palpated in the suprapubic region right at the midline. Gynecological examination shows a normal appearing vulva and lower vagina. The cervix cannot be visualized during get exam because of bluish bulging vaginal tissue obscuring the upper vagina. A urine pregnancy test is conducted and is negative. What is the most likely diagnosis in the patient?
Explanation: bulging vaginal tissue obscuring view of cervix = imperforate hymen
Question # 3
A 16 yer old female is brought to the clinic because she has never had a menstrual period. She also explains that she has had moderate lower back pain for the past 4 months. She has no notable past medical history, and takes no medications. She is 5 ft 5 inches tall, and weights 120 lb. Breast development is Tanner stage 4, and physical examination shows coarse axially and pubic hair. The external gentialia are unremarkable. The vaginal canal can not be visualized. Rectal exam reveals an anterior central mass that is tender. What most likely explains these findings in this patient?
Explanation: primary amenorrhea + unable to visualize vaginal canal + anterior tender mass on rectal exam = imperforate hymen (and accumulation of menstrual blood)
Question # 4
A 16 year old girl comes into the clinic becsaue of pelvic and lower abdominal pain. She explains that this pain starts at the beginning of each month, and resolves after a day or two. She believes the pain began about 7 months ago, and gets worse each month. She has never had a menstrual period. Both her and her boyfriend have not engaged in any type of sexual contact with each other. The patient’s weight, height and BMI are all within reference range. She has fully developed sexual characteristics. Physical exam reveals a palpable mass that is anterior to the rectum. Serum beta-hCG is negative. What is the most likely diagnosis in this patient?
Explanation: primary amenorrhea + absence of other “clues” for amenorrhea + anterior tender mass on rectal exam = imperforate hymen (and accumulation of menstrual blood)
Question # 5
A 14 year old girl comes to the clinic with her mother because she has been experiencing monthly lower abdominal pain for the past 5 months. She is 5 ft 3 in and weighs 110 lb (BMI is 20 kg/m²). Her temperature is 98.6°F, pulse is 75/min, reparations are 17/min, and blood pressure si 110/70 mm Hg. Physical exam reveals breast and pubic hair development is Tanner stage 4. An abodminla exam shows suprapubic tenderness and no masses. A gynecological exam shows a bluish red smooth bulge between the labia. What is the most likely diagnosis in this patient?
Explanation: bluish red smooth bulge between labia = imperforate hymen (and accumulation of menstrual blood).
Page Updated: 09.29.2016