# 3 Case Study
CASE 11
A 22-year-old G2P1 woman at 35 weeks’ gestation, who admits to cocaine abuse, complains of abdominal pain. She states that she has been experiencing moderate vaginal bleeding, no leakage of fluid per vagina, and has no history of trauma. On examination, her blood pressure is 150/90 mm Hg, and heart rate (HR) is 110 beats per minute (bpm). The fundus reveals tenderness, and a moderate amount of dark vaginal blood is noted in the vaginal vault. The ultrasound examination shows no placental abnormalities. The cervix is 1 cm dilated. The fetal heart tones are in the 160 to 170 bpm range.
What is the most likely diagnosis?
What are complications that can occur due to this situation?
What is the best management for this condition?
CASE 26
A 20-year-old parous woman complains of right breast pain and fever. She states that 3 weeks previously, she underwent a normal spontaneous vaginal delivery. She had been breast-feeding without difficulty until 2 days ago, when she noted progressive pain, induration, and redness to the right breast. On examination, her temperature is 102°F (38.8°C), blood pressure (BP) 100/70 mm Hg, and heart rate (HR) 110 beats per minute (bpm). Her neck is supple. Her right breast has induration on the upper outer region with redness and tenderness. There is also significant fluctuance noted in the breast tissue. The abdomen is nontender and there is no costovertebral angle tenderness. The pelvic examination is unremarkable.
What is the most likely diagnosis?
What is your next step in therapy?
What is the etiology of the condition?
CASE 41
An 18-year-old G1P0 adolescent female, who is pregnant at 7 weeks’ gestation by last menstrual period, complains of a 2-day history of vaginal spotting and lower abdominal pain. She denies a history of sexually transmitted diseases. On examination, her blood pressure (BP) is 130/60 mm Hg, heart rate (HR) is 70 beats per minute, and temperature is 99°F (37.2°C). Her neck is supple and the heart examination is normal. The lungs are clear bilaterally. The abdomen is nontender and no masses are palpated. On pelvic examination, the uterus is 4-week size and nontender. There are no adnexal masses on pelvic examination. The cervix is closed to examination. The quantitative β-hCG level is 700 mIU/mL and a transvaginal ultrasound reveals an empty uterus and no adnexal masses.
What is your next step in the management of this patient?
CASE 42
A 35-year-old woman at 8 weeks’ gestation complains of crampy lower abdominal pain and vaginal bleeding. She states that the pain was intense last night, and that something that looked like liver passed per vagina. After that, the pain subsided tremendously as did the vaginal bleeding. On examination, her blood pressure (BP) is 130/80 mm Hg, heart rate (HR) is 90 beats per minute, and temperature is 98°F (36.6°C). Her abdominal examination is unremarkable. The pelvic examination reveals normal external female genitalia. The cervix is closed and nontender and no adnexal masses are appreciated.
What is the most likely diagnosis?
What is your next step in management?
CASE 46
A 22-year-old woman is seen by her physician for a routine physical examination. She seems to be up to date regarding her immunizations and has received the HPV vaccine. She has no family history of breast cancer. She denies breast leakage or prior medical problems. On examination, her blood pressure (BP) is 100/60 mm Hg. Her physical examination is unremarkable except for 1-cm, right, nontender breast mass. Her neck is supple, and the heart and lung examinations are normal. Palpation of her right breast reveals a firm, mobile, nontender, rubbery 1-cm mass in the upper outer quadrant. There are no skin abnormalities noted. No adenopathy is noted. The left breast is normal to palpation.
What is your next step?
What is the most likely diagnosis?