ZANYA

  QUESTION: A 26yr old comes to the emergency with sudden onset of lower abdominal pain starting 3hrs ago increasing in intensity. Vaginal spotting started 2hrs ago. Last menstrual period was 6weeks ago. She has been sexually active since age 17 with multiple partners. She is on foam contraception. She had an appendectomy some few years ago. She is afebrile and stable. Abdomen is flat with lower quadrant tenderness and rebound tenderness,right>left. Speculum exam- dark vaginal blood wihtout cervical purulence. Cevix is closed, thick but moderately tender to motion. Uterus is slightly enlarged. A)      What are your differential diagnoses? B)      What is the most likely diagnosis? C)      What will be your investigations?   SOLUTION: a)DIFFERENTIAL DIAGNOSES: 1)Right ectopic pregnancy 2)Pelvic inflammatory diseases( PID) 3)Ruptured ovarian cyst 4)Endometriosis 5)Abortion    ...

  QUESTION: A 30yr old woman with estimated gestational age of 40weeks, comes to the labour and delivery floor with contractions of 3minutes and spontaneous rupture of membranes for 2hrs. She has gestational diabetes, which is diet controlled. Her blood type is A+. Pelvic examination reveals 4cm of cervical dilatation,90% effacement and the vertex of -2 station. Labour is augmented with oxytocin and progresses without complications. A girl was delivered with APGAR score of 9 in both   minute 1 and minute 5. Her birthweight is 3800g. The newborn is examined by the pediatrician and noted as appropriate for gestational age. She is breastfeeding without difficulty upon discharge from the hospital. Two days after discharge, the mother brings the newborn to the clinic because she notes her baby appears to be ‘yellow’. Physical examination is within normal limits, except for the clinical jaundice, especially in the face. a)What are your differential diagnoses? b)What will...

  QUESTION: A 3 week old boy is brought to the emergency room with a history of vomiting after each feeding. The symptoms started 2 days ago and have been worsening over the last 24hrs. The mother describes the vomiting as projectile, non-bilous and occurring within half an hour after feeding. He has appeared to be a bit lethargic over the last 12hrs. There is no history of fever or diarrhea. The mother states that the infant wants to have the formula and is hungry. She fed him about 20mins ago and urine was passed within the hour. a)Give 5 differential diagnoses b)What will be your investigations? c)What will be the most likely diagnoses if potassium and chloride are low but bicarbonates are high? d)What will be your treatment plan?   SOLUTION: a)Differentials: 1)Pyloric stenosis 2)Gastroesophageal reflux 3)Viral gastroenteritis 4)Duodenal atresia 5)Antral web   b) Investigations: -FBC -Electrolytes -Urinalysis -Abdominopelvic ultras...

  QUESTION: A 24yr old G1P0(gravida 1 para 0) at 8weeks presents to the clinic  with vaginal bleeding and minimal lower abdominal cramping. There is no history of trauma, no nausea, no vomiting and no dysuria. Last intercourse was 2 weeks ago. She is afebrile with stable vital signs. Abdomen soft, non-distended with minimal suprapubic tenderness. Speculum exam; small amount of dark red vaginal blood. Cervix is closed without lesions. Bimanual exam; slightly enlarged, symmetrical and non-tender uterus. There’s no cervical motion tenderness. a)       A)  What are your differential diagnoses? b)       B)  What is the most likely diagnosis? c)       C)   What investigations would you request? d)       D)  How would you manage this case?     SOLUTION: a)Differential diagnoses: 1)Threatened abortion 2)Hydatidiform mole 3)Ectopic pregnancy 4)Missed abortion 5)Inevitable abortion 6)Incomplet...