Female Athlete Triad

Chapter 171 Female Athlete Triad




Clinical Case Problem 1: A 20-Year-Old Female Runner with “Shin Splints”


A 20-year-old cross-country runner presents for evaluation of “shin splints.” She is a competitive runner, averaging approximately 50 to 60 miles per week. On examination, the patient is a small, thin woman with well-defined musculature. She has some tenderness over both medial tibias but has one discrete area of increased point tenderness 3   cm proximal to the medial malleolus. Her coach is waiting outside to find out when she will be able to return to running because they have an important meet next weekend.



Select the best answer to the following questions




1. What is the most important piece of history to obtain from this patient when a stress fracture is suspected?


a. whether she has been icing the painful areas

b. complete menstrual history

c. how much she stretches before exercise

d. medications that she is taking

e. types of surfaces on which she runs

2. The female athlete triad consists of which of the following?


a. anorexia, oligomenorrhea, calcium deficiency

b. osteoporosis, stress fractures, calcium deficiency

c. disordered eating, amenorrhea, osteoporosis

d. disordered eating, use of laxatives, osteoporosis

e. metamenorrhagia, hypothalamic dysfunction, osteoporosis

3. When is the best time to screen female athletes for risk factors for the female athlete triad?


a. at the preparticipation physical examination

b. when the patient presents with an injury

c. when the clinician notices that the patient is underweight or losing weight

d. when the patient presents for a routine Pap test and pelvic examination

e. after competition is complete for the season

4. What critical questions should be asked in obtaining a history from a female athlete?


a. age at menarche, regularity, and date of last menstrual period

b. whether the patient is happy with her weight and the patient’s idea of her ideal body weight

c. maximum and minimum weights that the patient has achieved

d. history of any stress injuries or stress fractures

e. all of the above


Clinical Case Problem 2: An 18-Year-Old Woman with Amenorrhea


An 18-year-old woman comes to the office with a complaint of amenorrhea. She experienced menarche at the age of 14   years; since that time, she has been having approximately four to six menses per year. However, her last menstrual period was 9   months ago. She is a competitive gymnast and travels a great deal with her team and coaches. She says that she knows that it is “normal” for athletes to miss their periods but that her mother had wanted her to come in. She wants to know if there is any medication that you can give her that “won’t make me fat.”



5. Amenorrhea in the athlete is most specifically associated with which of the following?


a. decreased levels of estrogen

b. increased levels of progesterone

c. calcium deficiency

d. use of laxatives to lose weight

e. exercise

6. Workup for amenorrhea of more than 6   months’ duration in a female athlete could include all except which of the following?


a. dual-energy x-ray absorptiometry (DEXA) bone mineral density scan

b. serum electrolytes, complete blood count, thyroid panel, and hormonal evaluation

c. pelvic examination

d. ultrasound examination of the abdomen and pelvis

e. psychological evaluation

7. All except which of the following are characteristics of anorexia nervosa?


a. distorted body image and excessive fear of gaining weight

b. amenorrhea

c. complete recovery in 50% of patients with counseling

d. weight below the 85th percentile for age and height

e. severe restriction of calories

8. Which of the following statements is true?


a. there are optimal body fat percentages specific to each sport

b. athletes with disordered eating habits often disclose this information on the first visit

c. teammates are almost always aware of another athlete’s disordered eating behaviors

d. coaches and parents may promote and perpetuate disordered eating by emphasizing the importance of winning and slim physiques

e. calorie needs are the same for each athlete

9. Which of the following statements is true?


a. the primary care provider is usually able to care for a patient with the female athlete triad without the involvement of others

b. a patient with the female athlete triad should be treated by a multidisciplinary team including the primary care physician, a nutritionist, a psychologist or psychiatrist, coaches, trainers, and parents

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Female Athlete Triad

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