Prepubertal Adnexal Mass

An 8-year-old patient is evaluated in the emergency room for sudden onset of severe lower abdominal pain. A general surgery consult was obtained, and appendicitis is ruled out. An ultrasound of the pelvis is requested, and there is a 7-cm solid and irregular right adnexal mass. On examination the pelvic examination is consistent with a 7-cm right adnexal mass, and there is lower abdominal tenderness but no rebound present. Etiology. An adnexal mass in the prepubertal age group is abnormal....

Vaginal Discharge

A 25-year-old patient presents to the gynecologist's office complaining of a whitish vaginal discharge. The patient states that this is the first time that she has this complaint, and it is associated with vaginal pruritus. There is no significant medical history, and the patient is not on oral contraception. Visual inspection. The vulva and vagina should be examined for evidence of an inflam- S OoK matory response as well as the gross characteristics of the vaginal discharge seen on speculum...

Primary Amenorrhea

A 16-year-old girl is brought into the gynecologist's office by her mother because she has not had her first menses. She states that all her daughter's friends in school have menstruated, and she is concerned about her daughter's lack of menstruation. The patient has no significant personal or family history, and on examination she seems to be well-nourished, with adult breast development and pubic hair present. A pelvic examination is not performed at the initial office visit. Definition....

Postmenopausal Adnexal Mass

A 70-year-old patient comes into the gynecologist's office for annual examination. She complains of lower abdominal discomfort however, there is no weight loss or abdominal distention. On pelvic examination you find a nontender, 6-cm, solid, irregular, fixed adnexal mass. Her last examination was 1 year ago, which was normal, and it included an abnormal Pap smear. Definition. A pelvic mass that is identified after menopause. Ovaries in the postmenopausal age group should be atrophic, and...

Perinatal Infections

GROUP B (3-HEMOLYTIC STREPTOCOCCI (GBBS) A 20-year-old woman G2 PI is admitted to the birthing unit at 35 weeks' gestation in active labor at 6-cm dilation. Her prenatal course was unremarkable with the exception of a positive first-trimester urine culture that was positive for GBBS. Her first baby was hospitalized for 10 days after delivery for GBBS pneumonia. Pathophysiology. GBBS is a bacterium commonly found in normal GI tract flora. Thirty percent of women have asymptomatic vaginal...

Antenatal Care and Fetal Testing

Presumptive signs of pregnancy include amenorrhea, breast tenderness, nausea and vomiting, increased skin pigmentation, and skin striae. Probable signs of pregnancy include enlargement of the uterus, maternal sensation of uterine contractions or fetal movement, Hegar sign (softening of the junction between the corpus and cervix), and positive urine or serum j3-human chorionic gonadotropin ((3-hCG) testing. Positive signs of pregnancy include hearing fetal heart tones, sonogrwghwns perception of...

Premenarchal Vaginal Bleeding

An 8-year-old girl is brought by her mother to the gynecologist's office because of vaginal bleeding for 2 weeks. The girl states that she has not taken any medication and gives no history suggestive of sexual abuse. She does not complain of headache or visual disturbance and has been doing well in school. She has no other significant personal or family history. On physical examination she appears to be well developed without pubertal changes, and a pelvic examination was not performed at the...

Hypothyroidism

This condition is most commonly a primary thyroid defect and often results in anovulation and infertility. If uncontrolled it is associated with spontaneous abortion however, if pregnancy continues, the infant is healthy. If controlled with appropriate thyroid replacement, normal fertility and pregnancy outcomes are noted. Diagnosis. Demonstration of an elevated TSH. Management Supplemental thyroid hormone. A 25-year-old primigravida is 19 weeks' gestation. She has a 10 year history of...

Hypertension

A 19-year-old primigravlda is seen in the outpatient prenatal clinic for routine visit. She is at 32 weeks' gestation, confirmed by first trimester sonogram. She has no complaints. She denies headache, epigastric pain, or visual disturbances. She has gained 2 pounds since her last visit 2 weeks ago. On examination her blood pressure (BP) is 155 95, but on retake 10 min later it is back down to 125 72, which is her usual BP. She has only trace pedal edema. A spot urine dipstick is negative....

Pelvic Inflammatory Disease PID

A 19-year-old nulligravida presents to the emergency room with bilateral lower abdominal pelvic pain. The onset was 24 h ago after she had just finished her menstrual period. She is sexually active but using no contraception. Speculum examination reveals mucopurulent cervical discharge. Bimanual pelvic examination shows bilateral adnexal tenderness and cervical motion tenderness. She is afebrile. Her qualitative urinary p-hCG test is negative. Complete blood cell count (CBC) shows a WBC of...

Lymphogranuloma Venereum LGV

This disease is caused by the L serotype of Chlamydia trachomatis. It is uncommon in the United States. Symptoms. The initial lesion is a painless ulcer. Examination. A painless vesiculopustular eruption, usually on the vulva, spontaneously heals. This is replaced within a few weeks by perirectal adenopathy that can lead to abscesses and fistula formation. The classic clinical lesion is a double genitocrural fold, the groove sign. Diagnosis. A positive culture of pus aspirated from...

Premenopausal Adnexal Mass

A 22-year-old woman visits the gynecologist's office for annual examination and requests birth control pill medication. On pelvic examination a 6-cm left adnexal mass is palpable, and this is confirmed with ultrasound. The ultrasound is consistent with a simple cyst. She has no other significant personal or family history. A 28-year-old patient is seen in the emergency room complaining of lower abdominal discomfort for the last 5 days. She has no history of oral contraceptive medication, and...