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nbme 6 - calivirus
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04-10-2006, 09:41 AM
A healthy 24 yr old woman comes for routine health exam. Menses occur at regular 28 days and last 5-6 days. her last period was 3 wks ago. She take no medication. Bimanual exam shows 5 cm, mildly tender lft adnexa. Pregnancy test is negative. Most apt next step in management?
1. Repeat exam in 2 wks. 2. Measure CA-125 3. measure AFP 4. Laparoscopy 5. CT pelvis
04-10-2006, 10:10 AM
1. repeat exam in two weeks I suspect a physiological ovarian cyst. It is a enign cysts that regresses readily. WHAT if abdominal sono was in the options, would repeat exam in two weeks still be the right answer? Alibism
04-10-2006, 10:12 AM
then choose sonogram...........as bimanual measurement of cyst is not accurate.......by USG you can measure cyst size accurately and then further management depend on the size of cyst.
04-10-2006, 10:13 AM
repeat exam in 3 weks is a safest bet-- since it may be a simple cyst of reproductive year which may be just gone in 3 weeks---after 3 weeks also i will like to do usg not ct --as it is easy and noninvasive and gives solid cystic natureof cyst and also help us to find benign or malignant nature of the cyst,
afp can be done later' 3 weeks is ok to wait ca 125 is ovarian cancer but that comes later --not common in this age laparocopy is agood tool for endometriosis to see those powder burn and choclet cyst but she has got neither those clincaal features like dyspareunia infertility and dysmenorrhea ct pelvis for tumour is too early and ct is not the primary investigation to go here.
04-10-2006, 10:18 AM
but then what if its not a physiological cyst and you miss it on 1st encounter just becuase you had option of USG and you didnt do because its not c'mon in that age group.....so i think better not to miss diagnosis..........i would rather go for USG if its given in options....and then if on USG i found less than 6 cm cyst ..........i will ask her to come for follow up in 2-3 wks.
04-10-2006, 11:06 AM
1. Repeat exam in 2 wks.
this is the best. at this time 3wks= 6days for her period + 2 weeks (mid cycle) at this time she has ovulation pain mass which may cause pain (i dont remember what this disease called) |
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