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Case Studies

Case Studies. Am I ready to do office gyn?. Sally is a 23 y/o GoPo complaining of irregular bleeding Gyn Hx: sexually active uses condoms most times PE: 105 lb Abdomen soft nontender Pelvic exam: no vaginal bleeding, Cervix is closed nontender, uterus normal, adenexa neg. Test Results.

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Case Studies

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  1. Case Studies Am I ready to do office gyn?

  2. Sally is a 23 y/o GoPo complaining of irregular bleeding Gyn Hx: sexually active uses condoms most times PE: 105 lb Abdomen soft nontender Pelvic exam: no vaginal bleeding, Cervix is closed nontender, uterus normal, adenexa neg

  3. Test Results • Quantative Beta HCG < 1 • Ultrasound normal uterus, endometrium, and ovaries

  4. What if Ultrasound Shows • uterus 11x9x8 cm with multiple leiomyoma about 2-3 cm in diameter, endometrial thickness 6 mm, normal ovaries

  5. Sally returns after 3 months on her new birth control pill still having breakthrough bleeding Pelvic exam is normal Test: STD negative pregnancy test negative

  6. Judy returns for annual exam on Ortho Tricyclen Lo Social hx: married, monogamous She is complaining that she had regular periods for a while but now having breakthrough bleeding for 6 months Exam: Normal Differential diagnosis?

  7. Jenny is a 24 year old G1P0, LMP: 6 weeks ago CC: bleeding like period with severe cramps PI: +home pregnancy test last week, onset of menstral like bleeding with severe menstral cramps 6 hours ago PMH: negative

  8. Exam shows dilated cervix and tissue at the os. Next step? • Exam shows moderate amount of blood coming from a closed os? Next step? • Quant = 600. DDX • Quant = 1800, us = gestational sac. DDx? • Quant = 1800, us = shows thickened endometrium. DDx?

  9. Path Report Shows: • Chorionic villi. DDx? • No chorionic villi. DDx? • Hydatidiform mole or molar pregnancy or molar degeneration. What is the follow up?

  10. Mary is a 45 y/o G3P3 status post tubal ligation Menstral formula: 2 weeks/3 days heavy on day 1 PMH: negative Pelvic exam: Cervix normal, pap done Uterus 6 weeks size, irregular, firm, nontender Ovaries not enlarged, nontender

  11. Guidelines for Endometrial Biopsy • All women with history of AUB of 2-3 yrs duration • All women > 45 yrs old with AUB • All women who do not respond to treatment

  12. Endometrial Biopsy Results • Complex hyperplasia with atypia • Complex hyperplasia • Simple hyperplasia • Proliferative endometrium • Secretory endometrium

  13. Vicki is a 60 y/o complaining of 3 days of light bleeding 3 weeks ago PMH: Illnesses: diabetes controlled on diet mild hypertension Meds: Atenolol Continuous hormone replacement therapy Exam: 5’4”, 175 lb Pelvic: vagina slightly atrophic cervix stenotic, pap done uterus NS/NS adenexa negative

  14. Endometrial thickness • < 4 mm generally atrophic endometrium • > 4 mm you can’t rule out cancer

  15. 60 yr old menopausal female complaining of incontinence PI: leaking urine for several months now worse PMH: TAH/BSO for benign disease age 45 Lumbar disk fusion 1 years ago PE: Pelvic – 1st degree cystocoele and 1st degree rectocoele

  16. Complaining of urgency, frequency, nocturia, sudden loss of large amounts of urine • Residual urine 10 ml • Urine culture positive > 100,000 e-coli

  17. Loss of urine with coughing, sneezing, laughing, squatting, jumping • Residual 50 ml and culture negative • Residual > 200 ml

  18. 22 yr old female complaining of amenorrhea for 1 yr PI: LMP 1 yr ago prior menstral formula 28d/5d BC: none Gyn Hx delivered a baby 2 yrs ago PMH: Schizophrenic on anti-psychotic med Soc Hx: Occasionally sexually active without condoms PE: Thin female, no distress Breasts bilateral milky discharge Pelvic exam normal

  19. Prolactin 100 ng/ml., TSH 5.5 uU/ml., • Prolactin, TSH normal

  20. On 10/28/97, JP a 33 y/o G2P2 presented with a cc intermenstral spotting not associated with pain or activity Uses ortho cept correctly Delivered by repeat c/s 8/1/96, started on BCP in hospital did not return for pp exam. Exam and pap smear normal Recommend continue ortho cept and call if bleeding continued to be a problem

  21. 1/2/98 seen in hospital as consult cc RLQ pain for 2 weeks No vaginal bleeding, off ortho cept PMH remarkable for hemoptysis, CXRay lung nodules Exam showed enlarged liver, abdomenal tenderness normal pelvic exam CT of abdomen showed free blood, liver metastasis CT of head no lesions

  22. Open lung biopsy reveal choriocarcinoma Diagnosis: metastatic gestational trophoblastic disease Transfer to U of I for treatment, patient subsequently died from her disease

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