Patient A., 24 years old, complaining of sharp pains in the abdomen, which arose suddenly after physical exertion. Notes nausea, vomiting, dry mouth. Pulse – 120 beats / min, blood pressure 110/70 mm Hg. In the study: the uterus firm, painless, not increased. The left set of deep appendages are not determined, the right set of shortened to the right of the uterus is determined by the formation of a rounded shape elastic consistency, limited mobility, sharply painful on palpation, sizes 7h8h6 see. The blood test – HB – 120 g / l, leukocytes – 12300, ESR -thirty.
1.Diagnosis
What additional tests are recommending for refine the diagnosis
Task 2
Patient 55 years old applied to the gynecologist with complaints constant nagging abdominal pain, difficulty urination. In the history of some genera large fruit, complicating crotch iII degree. 4 years postmenopause. Gynecological status: there is a discrepancy leg muscles, lift the tail passage; straining outside the vulvar ring define by body of the uterus, and hypertrophied cervix; front and rear walls of the vagina are omitted.
1.Prelimanary diagnosis
What are possible complications in this disease
Task 3
The patient was 24 years old taken to hospital emergency brigade help in connection with complaints of cramping abdominal pain, profuse, clotted bleeding from the genital tract, weakness. BP 100/60 mm Hg. v., pulse 90 in 1 min, temperature bodies 37 ° C. Last normal menstruation 2 months ago. When vaginal study: the cervix is not eroded, cyanotic, outer mouth passes finger. The uterus is enlarged to 6 weeks of pregnancy, painless. Appendages on either side define by. The vaults deep, painless
What is most likely diagnosis?
2.Optimal volume of medical emergency?
Task 4
Patient I8 years complained of abdominal pain, fever up to 37,5 ° C, purulent discharge from the genital tract, cramps while urinating. Sex life to 17 years, out of wedlock. Acutely ill, on the 7th day menstrual cycle, when the above symptoms. Gynecological status: urethra infiltrated , cervix hyperemic, edematous, with extensive erosion of from the cervical canal abundant mucopurulent allocation. Uterus not enlarged, painful on palpation, appendages on both sides thickened, painful, deep vaults. When bakterioskopio smears from urethra and cervical canal have been found diplococcs, located outside – and intracellularly.
Your diagnosis
Tactics of the doctor of female consultation.
Task 5
Patient 38 years old applied to the antenatal clinic with complains on recurrent abdominal pain, but on the left. Patients with chronic inflammation of the uterus, it was treated as an outpatient.
To the left and behind the uterus palpable ovoid shaped formation of 10 x 12 cm with a smooth surface, tight-elastic consistency, mobile, is not painful
1 Diagnosis.
2 What is advisable to survey make on an outpatient basis?
Task 6
The patient was 20 years complained of a delay the next menstrual period for 10 days. Blood pressure of 120/80 mm Hg. Art., pulse 72 in 1 min. With transvaginal ultrasound zapodo¬zrena progressing tubal pregnancy.
1.Right tactics of the doctor of female consultation.
2.Extra research methods
Task 7
The patient was 24 years old hospitalized in gynecology department for examination for primary infertility. From history: married 3 years, examined the husband is healthy. Mentruatsii regular, scanty, painful. Biphasic basal body temperature. When vaginal study: the uterus in antefleksii not increased, limited mobility; appendages on both sides thickened, sensitive to palpation; vaults deep.
What is the most likely cause of infertility in this patientWhat research methods should be used for diagnosis and origin of infertility?
Task 8
The patient was 45 years complained of heavy painful periods, “smearing” bleeding from the genital tract before and after menstruation. In the history of some urgent deliveries, three abortions, the last of which produced two years ago, complicated hematometra, further developed metroendometritis. In the study: the uterus in retro flexion, increased to the amount corresponding to 8-9 weeks of pregnancy, dense, limited mobility; appendages on both sides are determined, the parameters are free discharges slimy, bright.
What is the most likely diagnosis?
Identify the type of menstrual dysfunction
Task 9
The patient was 15 years old was admitted to hospital in connection with complaints of bleeding from the genital tract, which appeared after a delay of the next menstruation for 3 months and are continue within 12 days. From history: patients with chronic tonsillitom notes frequent nosebleeds. On examination; skin pale, pulse 82 in 1 min, rythmic, BP 110/70 mm Hg, a hemoglobin level of 90 g / l, hematocrit of 28%. When rektoabdominal researching: uterus normal size, firm, painless; appendages on both sides are not enlarged, from the genital tract bleeding, moderate.
With what disease may occur described the clinical picture?
What additional research is needed to hold the patient in order to clarify the diagnosis?
Task 10
30 year-old woman went to the doctor because of heavy bleeding from the vagina and pain in the iliac region. Last menstrual period 8 weeks ago.
If bimanual examination: uterus is enlarged to the size of 7-8 weeks gestation dense. Secretions profuse bleeding. Ultrasound in the uterine cavity is defined by the ovum.
Your diagnosis
What research methods should be used to confirm the diagnosis
