QU25 years old woman with history of 3 inevitable abortion ,all were mimicking, inevitable abortion, the first at 16 weeks of gestation , the 2nd & 3 at 18 and 20 weeks respectively , she told you that a lot of investigation done for her & diagnosed to have bicomuate uterus Questions: (14 marks) A) What is the embryological development of the uterus? B) What is the pathology behind bicomuate uterus? C) What is its clinical presentation? . D) How it can be diagnosed E) What type of treatment can be offeredB // due to failure of mullerian duct fusion or failure of one to developC // - asymptomatic - infertility - mid trimester obortior| - preterm labour - obstructed labour - abnormal presentationD// - 4D color U/Sm - MRI - Laparoscopic - HSG - HysteroscopeA//. The lower ends of paramesonephrid ducts come together to midline then fuse & develop as uterus and cervix . The muscular layer of uterus and cervix formed by proliferation of mesenchyme cells around fused portion of ductE. //. Surgical : MetroplastyQ3/ For each of the following case scenario, please respond as requested. (14 marks) A)I7 years old single secondary school student whe noticed clear odorless, vaginal discharge thal is not associated with pain, itching or irritation the dischasge increases in ainounl nearly 2 weeks from the start of her menstrual flow, what is the diagnosis. How can you explain this discharge changing criteria?Q3/A * physiological vaginal discharge due to increase mucus production from cervix in mid cycle , pregnancy , and women using combined oral contraceptive pills . It occurred Without any pain or itching . : ey Discharge changing criteria ? @ bibl wads git Cragioderwent hysterectomy for menorrhagia presented at her 10° postoperative day with intense yulvovaginal itching, irritation, and, thick curdy vaginal discharge she is currently on broad spectrum antibiotics for microbiologically proven surgical wound infection. b) A48 years old un _What is the cause of this newly developed discharge? -How can you confirm your clinical diagnosis?re Q3; B: 1- Vulvoaginal candidiasis (VVC) 2- + Vaginal swab, Gram stain or wet film examination + Typing the species may be required in recurrent and in severe vvc.c) A 21 years old sexually active woman presented to outpatient gyn. Clinic with yellowish green frothy vaginal discharge with intense vulvovaginal irritation, and lower abdominal pain, on examination, the cervix was swollen edematous with punctuate hemorrhages on Wet mount preparation a Nagellated unicellular protozoan was isolated ~Name this causative microorganism? -Mention 2 main principles of management of this lady. - Mention drug of 1" choice.Case3/C A Trichomonas vaginalis B- Treatment principles « Both partners should be treated « Both partners should be screened for other STD Cc Metronidazole single oral dose of 2g, (cheaper, more patient compliance) 400mg twice daily for 5-7 days both give cure 95% of cases Tinidazole 2g single oral dose equally effective, more cost.d) A 56 years old woman used to have superficial dyspareunia and vaginal dryness over the last few years nowadays she is bothered by purulent offensive vaginal discharge. -What were her initial symptoms attributed to ? -What was the cause behind changing her initial symptoms? -How do you treat both conditions?Q3-D: 1- Due to ((Atrophic Vaginitis)). 2- Because of complicated by ((true bacterial vaginitis) ) with strep. or other organism. 3- Atrophic V. ==> estrogen replacement with either local or systemic estrogen therapy. Bac. V. ==> appropriate antibiotic therapyHOES IS YALE woman presents with abdominal pain. It started suddenly 4 h ago and was initially in the lower sbdomen but is now gencralized. She feels nauseated and dizzy, especially when she sits up, She also feels shoulder pain. She had noticed sight vaginal bleeding , no discharge, and there are no bowel or urinary symptoms. Her last period y dates was about one month ago. She was diaynioued with cane when she was admitted to he infection, There is no other medical history of note 2 wet « poise at De aye of 1Y y On examination she is pale and looks unwell. She is wiertitvent\y rowsy. She is fying flat and still on the bed. ‘The ternperauue pulse 120'min and blood pressure 90°50 monly. Peripteral and the hands are clarnmy. She is generally sla but tve aidoruen is symmetrically distended. There is generalized tenderness oo tigi palpation, with rebound tendemess end guarding, Thee as 7 ov vay palpable masses and. Urinary pregnency test was positive Questions: (18 suates) As What is the diagnosis? B+ What is the major risk from this problem’? Ce List two risk factors this patient had for such # probe’? De what is other important investigatory method? E* How would you resuscitate aod manage the patien.Q4: A- Ectopic pregnancy g B- - increase mortality rate - increase fatality rate - The tube may rupture (acute presentation) ~ tubal abortion - less commonly, tubal mole - rarely, secondary abdominal pregnancy Cc. - increasing maternal age - aproven pelvic inflammatory disease(Chlamydia)D- - hCG and transvaginal ultrasound (first line for diagnosis ) Others: - laparoscopy - culdocentesis E- Treatment of the haemodynamically unstable patient: Resuscitation + 2 large-bore IV lines and IV fluids (colloids or crystalloids). * Cross match 6 units of blood » Call senior help and anaesthetic assistance urgently. Surgery + Laparotomy with salpingectomy once the patient has been resuscitated. 0€pe 14 years old girl presented by her mother with 2 compizio of primary amenorrhea . during history taken she said thet the gt) neve regular attacks of lower abdominal pain , nauses & vomtiag wt occasional attacks of difficulty in micturition {14 meres} Questions: A)What is the most likely diagnosis? B) How you prove it? C) How do you treat the girl? D) Is their any future sequelly from this disease 19 the ni’?Qs5/ 1- Imperforated Hymen, 2- By Examination, shows tense bulging membrane (which is the hymen) And By U/S shows hematometra and hematocolpos. 3- simple excision after family agreement & hospital certificate. 4- NO. 1720 PM |