The patient is a teenage girl with a history of Turner syndrome (monosomy X) that was diagnosed by the patient’s poor growth at age 4 years. At age 12 years, she presented with short stature and elevated levels of follicle-stimulating hormone and luteinizing hormone, and she was told that she would not menstruate.

At age 15 years, the patient presented to the clinic with episodes of vaginal bleeding. She had noted small amounts of blood being discharged intermittently during the previous 4 months. She had no associated abdominal pain, fever, dizziness, or shortness of breath. There was no history of nosebleeds or easy bruising and no family history of a bleeding disorder.  

On examination, the patient had mild pallor but was well perfused. She had no lymphadenopathy and her respiratory and cardiovascular examination was normal. Her abdomen was scaphoid and nontender with no organomegaly. She had Tanner stage 1 breast and pubic hair development. Bright red blood was seen at the introitus but a speculum exam was deferred.

Initial complete blood count showed the following levels: white blood cells, 8.4; hemoglobin, 9.9; hematocrit, 29.5; mean corpuscular volume, 62; and platelet count, 235.

Which of the following is the MOST important test that will assist with your diagnosis?

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Allison Byrd, Tanya Brown, Vanessa Davis
Cook County Health and Hospital Systems
John H Stroger Hospital
Chicago, IL

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