READ THE FOLLOWING CLINICAL PRESENTATIONS

 AND THEN ANSWER THE SUBSEQUENT QUESTIONS

(1) A 45-year-old woman P3+1 presented complaining of serosanguinous vaginal

discharge for two months duration

a) What are further poit! that "ou#$ %e i&portat i the hi!tor' of thi! patiet(

 %) What i! 'our $ifferetia# $iao!i! a$ ho* to i+e!tiate for thi! pro%#e&(

") Di!"u!! 'our further &aae&et,

(!) A "#-year-old woman who had $een in good health until appro%imately " months

ago &he presents with increased a$dominal discomfort' distension and persistent

fullness he patient denies significant past medical or surgical diseases enopause

was at the age of 55 years' and she has no past history of disorders of pregnancy or

gynecologic diseases

he patient is married and has ! daughters

*%amination of the a$domen shows o$vious a$dominal distention A fluid wave is

present' with shifting dullness o masses are appreciated

,ecto-vaginal e%amination demonstrates a large' firm mass in the right adne%a and

nodularity in the cul-de-sac he limits of the mass cannot $e e%actly determined A

chest radiograph shows a small' right-sided pleural effusion

A computed tomography () scan reveals a 1!-cm mass of heterogeneous te%ture

in the right ovary A large .uantity of ascites is present

a) What i! the &o!t pro%a%#e $iao!i!(

 %) -etio $ifferetia# $iao!i!,

") -etio &etho$! to rea"h $efiite $iao!i!,$) What are the !u%!e.uet !tep! i the &aae&et(

e) What are the po!!i%#e "o&p#i"atio! of the "o$itio(

(3) A /ravida 4' para 4' having an intrauterine device for one year &he is having

regular menstrual cycle and her 0P was ! wees previously &he presented with

ina$ility to feel the threads of the device

a) What are the po!!i%#e "au!e!(

 %) What i+e!tiatio! are ee$e$(

") What i! the proto"o# of &aae&et(

(4) A !!-year-old married for four years presented $ecause of ina$ility to conceive

&he is having vague lower a$dominal discomfort with e%aggeration of the symptoms

during the menstrual flow with the pattern of congestive dysmenorrhea Previous

hystrosalpingography was normal and ultrasound study of the pelvis did not show

any a$normality

a) What are the &o!t pro%a%#e "au!e! of iferti#it'( %) What further i+e!tiatio! are ee$e$(

") What are the !u%!e.uet pro"e$ure! ee$e$ to he#p the patiet(

 

(5) A 15-year-old girl present at the clinic with her mother as she has not yet started

menstruation here is history of periodic suprapu$ic discomfort 2n general

e%amination the secondary se% characters are normally developed and no o$vious

reason for her pro$lem A non-tender fullness is noted in the lower a$domen that is

dull in percussion

a) What are the po!!i%#e "au!e!( %) What i! the e/p#aatio of the perio$i" $i!"o&fort a$ the fu##e!! i the #o*er

a%$o&e(

") What are 0e' i+e!tiatio! to %e or$ere$($) What i&&e$iate iterfere"e i! ee$e$(

(") A !3-year-old single woman present with secondary amenorrhea for 3 months

here is history of oligomenorrhea &he noticed mily discharge from $oth nipples

for the last month Apart from $reast secretion general and a$dominal e%amination

was unremara$le

a) What i! the &o!t #i0e#' $iao!i!( %) What #a%orator' a$ i&ai i+e!tiatio! to %e or$ere$(

") What are the &e$i"a# &etho$! of &aae&et(

$) I! there a' ro#e for !urer' i that "a!e(e) What i! the effe"t of that "o$itio i future ferti#it'(

(#) A 4"-year-old gravida 3 para 3' presented with menorrhagia for 5 months he

menstrual flow lasts for a$out 1 days with unusually heavy flow &he looed pale

linical e%amination did not reveal any pelvic pathology

a) What #a%orator' i+e!tiatio! to %e or$ere$(

 %) What i&ai te"hi.ue! are u!efu#(") What are the po!!i%#e "au!e!(

$) What i! the po!!i%i#it' of &a#iat $i!ea!e i !u"h "a!e(

e) I! there a' ro#e for !urer' i the &aae&et(

 

() A 3!-year-old nursing woman having an intrauterine contraceptive device for si%

months &he had no menstrual flow for three months' and had lower a$dominal

pain and spotting for a couple of wees

a) What are the po!!i%#e patho#oi"a# #e!io!(

 %) What are the i+e!tiatio! that "ou#$ he#p to rea"h $iao!i!(

") Ho* *ou#$ 'ou a"t to &aae(