art 1: Choose 1 from the three (3) scenarios below
Abnormal uterine bleeding is a common gynecologic complaint. Review the following scenarios and determine a likely cause and describe the mechanism that leads to the abnormal bleeding pattern.
Scenario 1: A 13-year-old girl is having episodes of amenorrhea and infrequent menses. Her menarche was at the age of 12, she denies being sexually active, and a urine pregnancy test is negative.
Part 2
Epididymitis and testicular torsion are both causes of scrotal pain. Testicular torsion requires prompt recognition and surgical intervention to avoid testicular damage. Epididymitis is easily managed with antibiotics. Differentiation between the two disorders is important. Review the case and answer the questions.
Case
A 15-year-old presents to the emergency department complaining of sudden onset of right-sided scrotal and groin pain. He states the pain is constant and extreme. He said it started about 2 hours ago during basketball practice at school, but he denies any trauma to the scrotum. He is worried that he has a sexually transmitted infection as he just started having sexual intercourse with his girlfriend and he did not use condoms. He says he feels nauseated and thinks he is going to vomit. He said he noticed this same pain once before, but it went away within a few seconds and he did not tell anyone.
Physical examination reveals a healthy-appearing adolescent who is anxious and grimacing. The patient has edema and erythema of his right scrotum. His scrotum is tender, and the patient only tolerated superficial palpation. Vital signs: temperature 98.9°F; pulse 100 beats per minute; respirations 20 per minute; blood pressure 120/70 mmHg.
Answer the following questions or provide responses based on this case.
1. The most likely diagnosis based on his history is:
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- Epididymitis
- Testicular torsion
2. Erythema and edema of the scrotum are only present with epididymitis. True or False
3. Which clinical manifestations are consistent with epididymitis, and which are consistent with testicular torsion?
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- Positive Prehn sign
- Negative cremasteric reflex
- Testis elevated on affected side
- Fever
4. Which diagnostic test is most appropriate to confirm the suspected diagnosis?
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- A complete blood count with differential
- An MRI of the scrotum
- A Doppler ultrasound of the scrotum
- A urine culture and sensitivity
5. Discuss the treatment plans for testicular torsion and epididymitis.
Part 3
Most women at some point in their life will get a vaginal infection. Vaginal infection can be characterized by complaints of vaginal discharge. Three common causes of vaginal discharge are bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis. Review the following case and answer the questions.
Case
A 40-year-old woman comes in complaining of an increased thin whitish vaginal discharge that started about 5 days ago. She said it is so much that she needs to wear a small sanitary pad. She also noted that she had a funny odor after having sexual intercourse, and she says the odor continues despite her attempts to control it with douching. Physical examination reveals a thin white discharge around the vaginal wall with no erythema. Examination of the discharge includes a positive KOH whiff test and a vaginal pH > 4.5. Vaginal microscopy reveals clue cells.
Answer the following questions or provide responses based on this case.
1. What is a likely cause of the vaginal discharge?
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- Trichomoniasis
- Bacterial vaginosis
- Vulvovaginal candidiasis
2. Which of the clinical manifestations confirms the diagnosis?
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- The thin white discharge
- Malodorous discharge
- Presence of clue cells on a saline wet mount slide
3. The cause of this vaginal discharge disorder is due to:
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- An alteration in the vaginal flora
- Overgrowth of yeast due to antibiotic use
- A sexually transmitted organism, T. pallidum
4. This item is optional. Which is the primary treatment of this vaginal discharge disorder?
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- Fluconazole
- Metronidazole
- Clindamycin
5. Describe the mode of transmission, common organism, clinical manifestations, and treatment of the other two diagnoses not chosen in question 1.
