Problem-Based Clinical Cases Obstetrics and Gynecology Rotation Gyn Cases Updated March 2015 OB Cases Updated March 2015 By Medical Student and Resident Education Committee Table of Contents Section I: General Gynecology Page 4. Breast Disorders ..................................................................................................................................... 4 5. Contraception ......................................................................................................................................... 5 7. Dysmenorrhea ........................................................................................................................................ 7 8. Dyspareunia ........................................................................................................................................... 9 9. Ectopic Pregnancy................................................................................................................................ 12 10. Enlarged Uterus ................................................................................................................................... 13 19. Menorrhagia ......................................................................................................................................... 15 23. Pelvic Relaxation .................................................................................................................................. 16 25. Postmenopausal Bleeding .................................................................................................................... 17 26. Postmenopausal Pelvic Mass ............................................................................................................... 18 30. Premenopausal Pelvic Mass ................................................................................................................ 20 31. Premenstrual Syndrome ....................................................................................................................... 21 33. Prepubertal Pelvic Mass ....................................................................................................................... 22 38. Rape Victim .......................................................................................................................................... 22 44. Sterilization ........................................................................................................................................... 24 47. Urinary Incontinence............................................................................................................................. 25 49. Vaginal Discharge / Itching ................................................................................................................... 26 50. Vulvar Lesions ...................................................................................................................................... 27 51. Preventative Care and Routine Screening ........................................................................................... 28 Section II: Endocrinology and Fertility 15. Hirsutism/Virilization ............................................................................................................................. 29 18. Menopause ........................................................................................................................................... 29 28. Precocious Puberty .............................................................................................................................. 31 35. Primary Amenorrhea ............................................................................................................................ 33 36. Primary Infertility ................................................................................................................................... 36 41. Secondary Amenorrhea ........................................................................................................................ 38 42. Secondary Infertility .............................................................................................................................. 40 Section III: Gynecologic Oncology 2. Abnormal Pap Smear ........................................................................................................................... 41 22. Ovarian Cancer .................................................................................................................................... 44 46. Trophoblastic Disease .......................................................................................................................... 47 Section IV: Infectious Disease 40. Salpingitis ............................................................................................................................................. 49 43. Sexually Transmitted Diseases ............................................................................................................ 51 Section V: Prenatal Care 3. Anemia in Pregnancy ........................................................................................................................... 53 6. Discrepant Fundal Size ........................................................................................................................ 54 11. Fetal Demise ........................................................................................................................................ 56 13. First Trimester Bleeding ....................................................................................................................... 57 14. Glucose Intolerance in Pregnancy ........................................................................................................ 59 16. Hypertension in Pregnancy .................................................................................................................. 61 17. Isoimmunization ................................................................................................................................... 63 20. Multiple Gestation ................................................................................................................................. 64 32. Prenatal Diagnosis ............................................................................................................................... 66 45. Third Trimester Bleeding ...................................................................................................................... 67 48. Urinary Tract Infection in Pregnancy .................................................................................................... 69 Section VI: Obstetrics 1. Abnormal Labor .................................................................................................................................... 71 12. Fetal Distress ....................................................................................................................................... 73 21. Operative Obstetrics ............................................................................................................................. 74 24. Post Dates ............................................................................................................................................ 76 27. Postpartum Hemorrhage ...................................................................................................................... 77 29. Premature Rupture of Membranes ....................................................................................................... 79 34. Preterm Labor ...................................................................................................................................... 81 37. Puerperal Infection ............................................................................................................................... 82 39. Rectovaginal Fistula ............................................................................................................................. 84 OB/GYN Problem-Based Clinical Cases 2015 Section I: General Gynecology Section I: General Gynecology 4. Breast Disorders: 49 year-old Jean, G3 P2 Ab1, presents at your office complaining of a left breast lump. Your examination confirms a right breast upper outer quadrant 3 cm discrete, nontender, cystic mass. DDX: 1. Fibrocystic DZ -Most Common Breast Disease in -Tender with hyperplastic changes -due to decreased progesterone or increased estrogen -Get a mammogram to rule out cancer -FNA to help in diagnosis -Provera, Tamoxifen, Parlodel to treat, diuretic to decrease edema 2. Fibroadenoma -Most Common Benign Tumor -Well circumscribed and freely moveable -increased with pregnancy; regress with menopause -Treatment involves surgical excision -Usually found in females < 30 3. Intraductal papilloma -papillary growth within a duct -usually solitary and located under the areola -usually develops just before or during menopause -presents with bloody discharge -excisional biopsy of involved duct 4. Mammary duct ectasia (Comedomastitis, Plasma Cell Mastitis) -Common in 40’s -presents with nipple discharge -presents with pain and tenderness (due to dilation of the ducts ) -chronic intraductal and periductal inflammation 5. Galactocele -Ductal obstruction -milky thick discharge 6. Carcinoma - 90% ductal; 10% lobular (often bilateral) - Paget’s 3% arises in secretory dusts and skin of the areola - PM women have a greater