Clinical Case Study 16: Diagnosis and Management
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Questions and Answers

What is the most likely diagnosis for the patient with foul-smelling lochia and elevated WBC count?

  • Vaginitis
  • Pelvic inflammatory disease
  • Endometritis (correct)
  • Urinary tract infection
  • Which of the following is a likely etiology for the case involving the 20-year-old woman with cervical discharge?

  • Candidiasis
  • Bacterial vaginosis
  • Viral cervicitis
  • Chlamydia trachomatis infection (correct)
  • What is a clinical feature of the 27-year-old woman with amenorrhea?

  • Mild hirsutism and weight gain (correct)
  • Cervical motion tenderness
  • Bilateral adnexal tenderness
  • Soft abdomen
  • Which of the following would be a suitable management step for a patient with suspected endometritis?

    <p>Antibiotics and monitoring</p> Signup and view all the answers

    In a patient presenting with cervical motion tenderness and lower quadrant pain, what diagnostic evaluation would be most appropriate?

    <p>Ultrasound</p> Signup and view all the answers

    What risk factor is specifically noted in the case of the young woman with new sexual partners?

    <p>Multiple sexual partners</p> Signup and view all the answers

    What is an important aspect of prevention discussed in the cases involving sexually active young women?

    <p>Use of condoms</p> Signup and view all the answers

    What might be a common misconception about amenorrhea in a sexually active woman?

    <p>It is always indicative of pregnancy</p> Signup and view all the answers

    What is the most likely diagnosis for the 18-year-old woman with a yellow frothy discharge and vulvar itching?

    <p>Trichomoniasis</p> Signup and view all the answers

    In the case of the 36-year-old woman with fish-smelling discharge, what is the most likely diagnosis?

    <p>Bacterial vaginosis</p> Signup and view all the answers

    What clinical findings were noted during the examination of the 18-year-old patient?

    <p>Yellow malodorous discharge and vulvar erythema</p> Signup and view all the answers

    What treatment would be most appropriate for the diagnosed condition in the 18-year-old woman?

    <p>Metronidazole</p> Signup and view all the answers

    Which of the following is a risk factor identified in the case of the 36-year-old woman?

    <p>Recent antibiotic course</p> Signup and view all the answers

    What was the pH level of the vaginal discharge in the 18-year-old woman?

    <p>6.5</p> Signup and view all the answers

    What is a common etiology associated with the diagnosis made for the 36-year-old woman's symptoms?

    <p>Gardnerella vaginalis</p> Signup and view all the answers

    What complication could be expected in the 28-year-old woman after her cesarean section?

    <p>Wound infection</p> Signup and view all the answers

    What is the most likely diagnosis for the woman experiencing heavy vaginal bleeding at 7 weeks of gestation?

    <p>Incomplete abortion</p> Signup and view all the answers

    What is the most likely diagnosis for the 24-year-old woman presenting with severe abdominal pain and profuse vaginal bleeding?

    <p>Placental abruption</p> Signup and view all the answers

    What medication was prescribed to the woman with heavy vaginal bleeding?

    <p>Mifepristone followed by misoprostol</p> Signup and view all the answers

    What was observed on the transvaginal sonography of the woman experiencing heavy bleeding?

    <p>Enlarged uterus with partial retention of fetal products</p> Signup and view all the answers

    What is a significant diagnostic finding in the 24-year-old woman’s case indicating fetal distress?

    <p>No fetal cardiac activity on ultrasound</p> Signup and view all the answers

    What major risk factor is associated with the 31-year-old woman who has a history of preterm birth?

    <p>Previous preterm birth</p> Signup and view all the answers

    What vital sign noted upon the woman’s arrival at the emergency department indicated possible shock?

    <p>Heart rate of 110 beats per minute</p> Signup and view all the answers

    What is a common etiology for the bleeding observed in the multigravid nullipara woman?

    <p>Miscarriage</p> Signup and view all the answers

    What management strategy should be considered for the 31-year-old woman with positive fetal fibronectin test and cervical changes?

    <p>Tocolytic therapy</p> Signup and view all the answers

    What is the likely reason for the absence of fetal cardiac activity in the first case described?

    <p>Embryonic demise</p> Signup and view all the answers

    What is a typical sign of hypertension seen in the 23-year-old woman at the antenatal clinic?

    <p>Elevated blood pressure</p> Signup and view all the answers

    Which of the following complications is the 20-year-old woman likely experiencing due to her high blood pressure?

    <p>Preeclampsia</p> Signup and view all the answers

    What does a urinalysis showing +2 protein suggest in the context of the 23-year-old woman's symptoms?

    <p>Potential preeclampsia</p> Signup and view all the answers

    In the clinical context, what does 'multigravid multipara' indicate about the 31-year-old woman?

    <p>She has had multiple pregnancies and births</p> Signup and view all the answers

    What fetal gestational age was estimated via sonography for the woman who was found seizing?

    <p>33 weeks 3 days</p> Signup and view all the answers

    Which symptom is NOT associated with severe complications in pregnancy as seen in the 24-year-old woman’s case?

    <p>Mild nausea</p> Signup and view all the answers

    What condition is suggested by the presence of bilateral uterine adnexal tenderness and nodularity during a pelvic exam?

    <p>Endometriosis</p> Signup and view all the answers

    Which is a common risk factor associated with infertility in women?

    <p>Pelvic inflammatory disease</p> Signup and view all the answers

    What might be an important step in the management of a patient diagnosed with endometriosis?

    <p>Medications such as NSAIDs)</p> Signup and view all the answers

    Which diagnostic evaluation would be most appropriate for a suspected ovarian mass?

    <p>Transvaginal sonography</p> Signup and view all the answers

    What symptom is commonly associated with cervical irritation or inflammation in women?

    <p>Intermenstrual spotting</p> Signup and view all the answers

    What is a potential consequence of untreated endometriosis?

    <p>Chronic pelvic pain</p> Signup and view all the answers

    How might a family history impact a woman's risk for developing endometriosis?

    <p>It increases the risk</p> Signup and view all the answers

    Which factor can contribute to the onset of mild discomfort during sexual intercourse?

    <p>Certain medical conditions</p> Signup and view all the answers

    Study Notes

    Clinical Case Summaries

    Case 16

    • Likely diagnosis: Trichomoniasis, indicated by yellow, frothy, malodorous discharge, and vulvar itching.
    • Etiology: Caused by the protozoan parasite Trichomonas vaginalis.
    • Diagnostic evaluation: Examination reveals vaginal discharge with a pH of 6.5; 10% KOH test negative for amine odor.
    • Management: Antibiotics (e.g., metronidazole) for treatment.
    • Risk factors: Unprotected sexual activity, multiple partners.

    Case 17

    • Likely diagnosis: Bacterial vaginosis, suggested by fish-smelling discharge and presence of stippled epithelial cells.
    • Etiology: Imbalance of vaginal flora, primarily due to a decrease in Lactobacilli.
    • Diagnostic evaluation: Microscopic examination shows decreased Lactobacilli, few WBCs, and specific bacterial flora.
    • Management: Metronidazole or clindamycin for treatment.
    • Risk factors: Sexual activity, douching, lack of condom use.

    Case 18

    • Likely diagnosis: Postoperative infection, possibly endometritis, indicated by fever and foul-smelling lochia.
    • Etiology: Bacterial infection following cesarean delivery.
    • Diagnostic evaluation: Elevated WBC count (17,000 cells/µL) and clinical symptoms post-surgery.
    • Management: Antibiotics and supportive care.
    • Risk factors: Prolonged rupture of membranes, cesarean delivery.

    Case 19

    • Likely diagnosis: Pelvic inflammatory disease (PID), signaled by lower abdominal pain and mucopurulent discharge.
    • Etiology: Result of untreated STIs, commonly Chlamydia or Gonorrhea.
    • Diagnostic evaluation: Pelvic examination showing cervical motion tenderness.
    • Management: Broad-spectrum antibiotics.
    • Risk factors: Multiple sexual partners, inconsistent condom use.

    Case 20

    • Likely diagnosis: Polycystic ovary syndrome (PCOS), suggested by amenorrhea, hirsutism, and weight gain.
    • Etiology: Hormonal imbalance affecting ovarian function.
    • Diagnostic evaluation: Serum hormone levels, ultrasound for ovarian cysts.
    • Management: Lifestyle changes, hormonal therapies.
    • Risk factors: Family history, obesity.

    Case 29

    • Likely diagnosis: Complete miscarriage (spontaneous abortion), indicated by heavy vaginal bleeding and non-viable pregnancy on ultrasound.
    • Etiology: Often due to chromosomal abnormalities.
    • Diagnostic evaluation: Ultrasound shows no fetal cardiac activity and retained products.
    • Management: Possible surgical intervention or medication to complete the miscarriage.
    • Risk factors: Previous pregnancy losses, advanced maternal age.

    Case 30

    • Likely diagnosis: Severe preeclampsia or eclampsia, suggested by hypertension and seizures at 33 weeks of pregnancy.
    • Etiology: Defective placentation leading to systemic vascular resistance.
    • Diagnostic evaluation: Blood pressure monitoring, laboratory tests for kidney function.
    • Management: Medications to control hypertension, magnesium sulfate for seizure prevention.
    • Risk factors: Previous history of hypertension, obesity.

    Case 31

    • Likely diagnosis: Placental abruption, indicated by severe abdominal pain, vaginal bleeding, and marked hypotension.
    • Etiology: Premature separation of placenta from the uterine wall.
    • Diagnostic evaluation: Clinical evaluation and ultrasound may reveal retroplacental hematoma.
    • Management: Emergency delivery may be necessary; assess maternal and fetal well-being.
    • Risk factors: Trauma, hypertension, smoking.

    Case 32

    • Likely diagnosis: Preterm labor, indicated by contractions and cervix changes at 31 weeks.
    • Etiology: Various factors; potential infection or cervical insufficiency.
    • Diagnostic evaluation: Fetal fibronectin test positive, cervical examination reveals effacement.
    • Management: Tocolytics to halt contractions, corticosteroids for fetal lung development.
    • Risk factors: Previous preterm birth, cervical surgery history.

    Case 33

    • Likely diagnosis: Gestational hypertension or preeclampsia, indicated by high blood pressure and proteinuria at 35 weeks.
    • Etiology: Unclear, but related to placental development.
    • Diagnostic evaluation: Urinalysis showing protein, blood pressure monitoring.
    • Management: Monitor closely, possibly induce labor if severe.
    • Risk factors: First pregnancy, family history of preeclampsia.

    Case 37

    • Likely diagnosis: Endometriosis, suggested by lower abdominal bloating and infertility.
    • Etiology: Presence of endometrial tissue outside the uterine cavity.
    • Diagnostic evaluation: Pelvic examination reveals adnexal masses; ultrasound shows ovarian masses.
    • Management: Pain management, hormonal therapy, or surgical options.
    • Risk factors: Family history, menstrual disorders.

    Case 38

    • Likely diagnosis: Possible cervical pathology or polyp, inferred from intermenstrual spotting post-intercourse.
    • Etiology: Various causes including hormonal imbalances or structural lesions.
    • Diagnostic evaluation: Pap smear and possible biopsy needed, given history of unremarkable findings.
    • Management: Monitor, treat any underlying conditions found in evaluation.
    • Risk factors: History of cervical issues, lack of regular gynecological check-ups.

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    Description

    This quiz focuses on a clinical case study involving an 18-year-old woman presenting with symptoms of vaginal discharge and irritation. Participants will explore potential diagnoses, etiology, diagnostic evaluation, management strategies, and risk factors for treatment. Ideal for students in healthcare fields seeking practical knowledge.

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