gyna

CASE A 32-year-old woman complains that she has not had a period for 3 months. Four home pregnancy tests have all been negative. She started her periods at the age of 15 years and until 30 years she had a normal 27-day cycle. She had one daughter by normal delivery 2 years ago, following which she breast-fed for 6 months. After that she had normal cycles again for several months and then her periods stopped abruptly. She was using the progesterone only pill for contraception while she was breast-feeding and stopped 6 months ago as she is keen to have another child. She reports symptoms of dryness during intercourse and has experienced sweating episodes at night as well as episodes of feeling extremely hot at any time of day. There is no relevant gynaecological history. The only medical history of note is that she has been hypothyroid for 10 years and takes thyroxine 100 μg per day. She does not take any alcohol, smo

amenorrhea

History A 29-year-old woman and her partner are seen in the gynaecology outpatient clinic with primary infertility. They stopped using condoms 2 years ago and have had regular inter- course since then. The partner has no previous medical history of note. He drinks approxi- mately 8 units of alcohol per week and does not smoke. He works as a manager in a hotel. The woman also has no specific previous medical history except for an appendectomy aged 12 years. Her periods occur every 31 to 46 days and can be heavy at times but not painful. There is no intermenstrual or postcoital bleeding. She has always had normal smears and has never had any sexually transmitted infections. She takes no medications, drinks approximately 6 units of alcohol per week and does not smoke. Examination On examination her body mass index (BMI) is 29 kg/m2. She has slight acne on her face and her chest. There are no abdominal scars and the abd

anouverltory due to pcos

CASE12 A 28-year-old woman attends the colposcopy clinic after an abnormal smear test. She is very anxious as she thinks that she might have cervical cancer. The smear is reported as 'severe dyskaryosis'. She had a previous normal result at age 25 years. She has not had any postcoital or intermenstrual bleeding. Her first sexual relationship started at the age of 14 years and she has had several partners since then. She lives with her current partner who she has been with for 3 years. She was diagnosed with genital herpes several years ago but has not had any attacks for at least 3 years. She smokes 15-20 cigarettes per day and drinks only at the weekends. She has an intrauterine contraceptive device in situ. 1).What is the diagnosis? (Examination with speculum, PAP test). 2). How would you further investigate and manage this woman?

cervical cancer

Chief Complaint "I am bleeding from my vagina." History and Physical Examination A 60-year-old obese woman presents to the clinic with complaint of vaginal bleeding. She reports that she has been having vaginal bleeding intermittently for the last 2 months. She states that this is her first episode since she went through menopause at age 52. Her medical history is significant for obesity (BMI = 44 kg/m2 ), non-insulin dependent diabetes and osteoarthritis. Her past surgical history is significant for a laparoscopic cholecystectomy and a remote history of a dilation and curettage for heavy, irregular vaginal bleeding. Her most recent Pap smear 2 years ago was normal. She has never been pregnant despite her and her husband not using any contraception. Vital signs are WNLexcept BP 155/90 mm Hg. Physical exam reveals a heavy-set woman in no acute distress. Pelvic exam show a normal appearing vulva, well estrogenized

endometrial cancer

Case 6 A patient presents for her first initial OB visit after having a positive home pregnancy test. She reports a last menstrual period of about 8 weeks ago. She says she is not entirely sure of her dates, however, because she has a long history of irregular menses. Her urine pregnancy test in your office is positive. Obstetrical history taking (CHECK LIST) Which of the following is the most accurate way of dating this patient's pregnancy? First trimester screening test what does it include ?

first day of her last menstruation

CASE11 A 36-year-old African-Caribbean woman has noticed abdominal swelling for 10 months. She has to wear larger clothes and people have asked her if she is pregnant, which she finds distressing having been trying to conceive. She has no abdominal pain and her bowel habit is normal. She feels nauseated when she eats large amounts. She has urinary frequency but no dysuria or haematuria. Her periods are regular, every 27 days, and have always been heavy, with clots and flooding on the second and third days. She has never received any treatment for her heavy periods. She has been with her partner for 7 years and despite not using contraception she has never been pregnant. Examination The woman has a very distended abdomen. A smooth firm mass is palpable extending from the symphysis pubis to midway between the umbilicus and the xiphisternum (equivalent to a 32-week size pregnancy). It is non-tender and mobile. It is not

giant uterine myoma

Uterine bleeding at 12 weeks gestation accompanied by cervical dilation without passage of tissue. Match this description with the correct type of abortion. Which type of miscarriage is it? (Provide investigation in speculume)

inervted abortion

Case History A 48-year-old woman presents with intermenstrual bleeding for 2 months. Episodes of bleeding occur any time in the cycle. This is usually fresh red blood and much lighter than a normal period. It can last for 1-6 days. There is no associated pain. She has no hot flushes or night sweats. She is sexually active and has not noticed vaginal dryness. She has three children and has used the progesterone only pill for contraception for 5 years. Her last smear test was 2 years ago and all smears have been normal. She takes no medi- cation and has no other relevant medical history. Examination PROVIDE PALPATION OF ABDOMEN AND VAGGINAL INVESTIGATION The diagnosis Differential diagnosis for intermenstrual bleeding , Management

intermenstrual bleeding

CASE 8 A girl 16 years old came to the doctor. She needs information about contraception. She has no complaints. Menstrual periods started at the age 12 years, moderate, painless. Sex life from 16 years. Somatic history is not burdened. She doesn't smoke. The general condition is satisfactory, blood pressure 120/70 mm Hg, pulse 68 beats./min. The abdomen is soft, painless. What examinations the patient is needed (vaginal examination, pap test)- CHECK lists 1. What methods of contraception you can recommend? Why? 2.What is fertile window?

mini pills condoms cop

Fetal death at 15 weeks gestation without expulsion of any fetal or maternal tissue for at least 8 weeks. Match this description with the correct type of abortion. Which type of miscarriage is it? (Provide investigation in speculume)

missed abortion

CASE13 History A 29-year-old woman and her partner are seen in the gynaecology outpatient clinic with primary infertility. They stopped using condoms 2 years ago and have had regular intercourse since then. The partner has no previous medical history of note. He drinks approximately 8 units of alcohol per week and does not smoke. He works as a manager in a hotel. The woman also has no specific previous medical history except for an appendectomy aged 12 years. Her periods occur every 31 to 46 days and can be heavy at times but not painful. There is no intermenstrual or postcoital bleeding. She has always had normal smears and has never had any sexually transmitted infections. She takes no medications, drinks approximately 6 units of alcohol per week and does not smoke. Examination On examination her body mass index (BMI) is 29 kg/m2 . She has slight acne on her face and her chest. There are no abdominal scars and the

polycystic ovary syndrome

Case A 16-year-old primigravida presents to your office at 32 weeks gestation. Her first trimester blood pressure was 100/72. Today it is 140/90 mm Hg and she has 2+ proteinuria on a clean catch specimen of urine. She has swelling of her face and extremities. She denies having contractions.She have(PPRM) Her cervix is closed and uneffaced. Take smear for GBS from vag (CHECK LIST OF GBS sampling) 1.Which is the best step in the management of this patient? 2.If GBS will be positive what are you going to do? 3.Wich complications may develop, how long we will continue this pregnancy?

pre term labour

A 39-year-old primigravida patient is attending the antenatal clinic. Pregnancy progresses normally to 28 weeks.She has diabetes mellitus from last 7 years,her pregnancy develop by IVF fertility. At the next visit at 32 weeks, the patient complains that her hands and feet have started to swell over the past week. On examining her, you notice that her face is also slightly swollen. Her blood pressure at present is 170/90, and she has proteinuria +5. Vag invest-cervix 50% effaced,4 sm dilation,anterior position,soft,statopn 0. What will be your suppose diagnosis? Which risk factors of this disease development does she have? Which methods of investigation you will use? What are the steps of management if it is sever preeclampsia and BPP-8?

precla,psia

CASE 7 23 years old primigravida came to the hospital with severe pain in the lower abdomen, pain start 3 hours ago, bleeding from vagina. Gestational age of pregnancy is 32 weeks. Pregnancy coexist with diabetes 2nd type. In the first trimester she had risk of miscarriage. You have to provide BM (CHEK LIST) investigation to check Bishop scoring 1.What does Bishop scoring include 2 How should you manage a patient with an antepartum hemorrhage of unknown cause?

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