Treatment Flashcards
A 46 year old woman presents with a 3 month history of painless post coital bleeding. She did not have other symptoms. She had her last smear test 10 years ago and that was normal
Cervical carcinoma
A 48 year old Afro-Caribbean woman presents with lower abdominal pain and heavy periods. On examination, she is found to have a bulky uterus. She is otherwise normal and healthy.
Fibroids
A 21 year old woman presents with bleeding and vaginal discharge. She also has a 3 month history of intermittent fever and abdominal pain. On examination, cervical excitation is found and there is purulent vaginal discharge.
Chlamydia trachomatis
A 62 year old postmenopausal woman has a 2 month history of weight loss and vaginal bleeding. She is obese and she lives with her husband. They have no children. Ultrasound scan shows a 9mm thick endometrium.
Endometrial carcinoma
A 24 year old woman has increasing pain during her menstruation for 3 months, She has heavy periods and the pain increases throughout menstruation.
Endometriosis
A 22 year old woman is a sex worker. She had a history of 2 abortions and she wanted to stop getting pregnant. She asked for female sterilization as she thought that would be the best way to stop getting pregnant.
Barrier method
A 45 year old woman had 3 children and feels she has completed her family. She wants a permanent method of contraception, and her husband will not consider vasectomy. What would you recommend?
Female sterelization
A 19 year old woman complained of heavy periods and dysmenorrhoea. She has a new boy friend and has recently become sexually active. She wants treatment for her periods as well as contraception.
IUCD
A 23 year old woman had unprotected sex at a party yesterday and would like to emergency contraception.
Morning after pill
A 26 year old comes to the clinic with her husband. She would like to have contraception. She is a busy person and often forgets to take her pills. She does not like the idea of a coil and does not like condoms.
Injectable progestrogens
A 25 year old woman presented to Emergency Department with a history of 2 hour lower left pelvic pain. She felt nauseous. On examination, she had a tender lower left abdomen with guarding and rebound. No bleeding was observed and her pregnancy test was negative.
Ovarian torsion
A 22 year old university student presented with fever and lower abdominal discomfort. She complained of vaginal discharge. She had a history of unprotected sex with multiple partners. On examination, she had cervical excitation.
Chlamydia trachomatis
A 27 year old woman was brought into the emergency department by her husband. She was complaining of severe lower left abdominal pain before she was found collapsed on the floor by her husband. Her last menstrual period was 2 months ago. She was tachycardic with BP 80/50.
Ectopic pregnancy
A 31 year old woman presented with a 5 year history of lower abdominal pain. She had episodes of pain nearly once every month before her menstruation. She also mentioned that she had problems in conceiving a child with her husband. On examination, tenderness was found on bimanual palpitation with a retroverted uterus.
Endometriosis
A 25 year old woman presented with an abdominal pain associated with heavy bleeding. She had a positive pregnancy test a week ago. On examination, there was no cervical excitation. Ultrasound showed an empty uterus.
Early miscarriage
A 36 year old lady presented with menorrhagia. It started 2 months ago and this is the first time that she suffered from heavy periods. She would like to have less blood loss. She has had 3 children and would like reliable contraception too.
Intrauterine system
A 24 year old non-smoking female presents with increasingly heavy periods for 3 months. She tried tranexamic acid for 3 cycles but that did not help. She currently has no children but would like to consider contraception for a short time as she is keen to try for a family over the next year or two. She would like to try another medication.
Combined oral contraceptive pill
A 44 year old African-Caribbean woman presented with pain and very heavy periods. On examination, she had a bulky uterus or about 16 week size. Her symptoms have a severe impact on her quality of life and would like to stop her periods. She has 4 children and has finished her family. Multiple fibroids were found on ultrasound scan of her pelvis (2 of them >4cm).
Hysterectomy
A 30 year old woman was complaining of heavy periods and abdominal pain. She has tried all medical management but it was not successful. A large fibroid protruding into the uterine cavity has been seen on ultrasound scan. She would like to retain her fertility and prefers not to have open surgery.
Hysteroscopic myomectomy
A 21 year old woman complains of heavy periods. They have been getting worse over the past 5 months. She has not had any treatment for her menorrhagia and is not keen on ‘hormones’ treatment.
Tranexamic acid
A 33 year old Afro-Caribbean woman is at term and in spontaneous labour. She has a history of heavy periods and a bulky uterus. Her pregnancy has been uneventful until spontaneous labour at term. During labour the head has failed to engage in the pelvis and can still be palpated abdominally and a smooth round mass can be felt abdominally and on cervical examination.
Cervical fibroids
A 28 year old multiparous woman was brought to the hospital after signs showing that she is in spontaneous labour. The fetus backbone could be felt uppermost in the uterus on abdominal examination. On vaginal examination, the pelvis is empty.
Transverse lie
A 23 year old woman primigravida is in spontaneous labour. Her labour is prolonged. Her contractions are fewer than 2 in ten minutes and last less than 60s.
Inefficient uterine action
A 26 year old woman is an insulin dependent diabetic, she admitted to the hospital after spontaneous rupture of membranes.. She was examined initially and found to be 6cm dilated, four hours later she is still 6cm dilated with excellent contractions. The fetal head has not descended.
Fetal macrosomia
A 32 year old primiparous woman has had a prolonged labour, with no change in dilatation of her cervix or descent of the fetal head. In her teens she has a history of serious trauma to her pelvis necessitating internal fixation.
Pelvic fractures
A 32 year-old woman is 23 weeks pregnant. She has had minor painless bleeds. She has had a 20-week anomaly scan which shows a low lying placenta.
Placenta praevia
A 24 year-old woman is 26 weeks pregnant. She has had a heavy bleed after she tripped and fell on to the ground in the morning. She has had severe pain in her abdomen and is admitted to the hospital by ambulance. On examination, she had a firm and tender uterus.
Placenta abruption
A 28 year-old woman is 20 weeks pregnant. She is complaining about vaginal spotting. She has had a fever and dysuria for 2 days. On examination, there are no signs of blood in the vagina.
Urinary tract infection
A 19 year-old woman has a history of 9 weeks amenorrhoea. She has had a positive home pregnancy test. 2 days later, she has had fresh vaginal bleeding. Ultrasound scan shows an empty uterus and on examination, she has a tender right adenexa with cervical excitation.
Ectopic pregnancy
A 21 year-old woman has a history of 10 weeks amenorrhoea. Since this morning she has had vaginal bleeding and has passed clots and tissue. On examination, no abnormality was found. Ultrasound scan shows an empty uterus.
Miscarriage
An 86 year old woman complains of urinary incontinence for several years. She mainly has incontinence when she coughs. She has had 5 children by vaginal delivery.
Genuine stress incontinence
A 74 year old woman presents with incontinence for over a month. She finds it difficult to hold on to go to the toilet and feels like she needs to go to the toilet all the time. She often wets her bed at night. She denies any problems of incontinence with coughing. On examination there was no abnormality found.
Detrusor overactivity
A 33 year old African woman delivered her third child last month in Africa. She had prolonged labour but both the baby and mother were fine in the end. For the past few days, she noticed that she is incontinent without any urge sensation. On examination, urine does not leak out when coughing. A small opening is observed in the upper part of her vagina. She said it was not painful and there was no abnormal bleeding.
Fistula formation
A 70 year old diabetic woman was presents with a 2 month history of urinary incontinence. She reports it as a gradual loss of sensation of fullness of her bladder and the situation has been getting worse over the past 2 months.
Neurological deficit
A 67 year old woman was presents with a 2 day history of fever and feeling generally unwell. She complains of episodes of irresistible sensation to pass urine in the past 2 days and haematuria.
Urinary tract infection
A 25 year old woman went for her first smear test and the result was normal.
Repeat smear test in 3 years
A 28 year old woman went for her smear test and the result showed that she had mild dyskaryosis. The sample tests negative for human pipilloma virus (HPV).
Repeat smear test in 3 years
A 64 year old lady had just had her smear test. Her previous result and this result were both negative.
Remove from the screening programme
A 32 year old woman had her LLETZ 6 months ago. Her smear is HPV positive.
Refer to colposcopy
A 42 year old woman had moderate dyskaryosis on her smear test result, her previous test was normal.
Refer to colposcopy
