Name :- Harshita Shrivastava

Group :- 3
Course :- 4th

Question 1 :- Ureaplasmosis and micoplasmosis: clinics, diagnostics, treatment.

Ureaplasmosis and mycoplasmosis, is Sexually transmitted diseases. Ureaplasma belongs to

a class of bacteria known as Mycoplasma. Mycoplasma - the smallest microorganisms that
live in the mucous membranes of the mouth, respiratory tract, the lower parts of the urogenital
tract. In inflammatory diseases of the genital organs of women, these microorganisms affect
the vagina, cervix, endometrium, fallopian tubes. Mycoplasma is spread through sexual contact

● Ureaplasma infection may cause some conditions that lead to pain and discomfort in the
genital area like - Urethritis, Bacterial vaginosis.
● CLINICS - Meager Discharges from urethra or vagina, there can be itching in urethra, in
the external genital . Pain in the groin, perineum.
● The main laboratory diagnostic methods are mycoplasmosis isolation of a pure culture of
mycoplasmas in the culture media and the establishment of their kind.
● Treatment involves a course of antibiotics - azithromycin or doxycycline are prescribed.
● The most effective antibiotics: tetracycline, monomitsin, kanamycin, chloramphenicol,
lincomycin

Situational task :- Woman, 36 years old, addressed general practitioner with complaints
on discomfort in the area of external genitalia, unpleasant smell. The named complaints
appeared in winter after she had a prolonged cold.
From anamnesis: menstruations since 12 years old (for 4-5 days, cycle - 30 days),
regular, moderate, painless. The woman had 2 pregnancies; the first one – medical
abortion, the second – full-term delivery of alive boy. She has no history of
gynecological diseases. Objectively: general condition of the patient is satisfactory.
Pulse - 76 beats/min, also filling and pressure. BP - 120/70 mm Hg. Temperature –
36.6°C. Skin and visible mucous membranes are of usual color, clean. Pathology of
internal organs is not revealed. Abdomen is soft, painless on palpation. Other
physiological parameters are normal. Examination in specula: mucous of vagina is light
pink. There is a congestion watery grayish discharge with an unpleasant & “fishy ”
smell in the posterior vaginal vault, vaginal рН is 5,0 - 5,5.
Bimanual examination: vagina of a porous woman. Cervix of the uterus is cylindrical,
the canal is closed and shifting of the cervix is painless. Uterus is in anteflexion-version
position, of usual sizes, dense, mobile and painless. Appendages on both sides are not
enlarged and are painless. Vaginal vaults are deep and painless.
Microbiological examination: in analysis of microflora of vagina, cervical canal and
urethra – a lot of leucocytes, key cells. On PCR (identification of DNA of the infectious
agent) and ELISA examination Gardnerella vaginalis is found out. Select from the text
laboratory
data confirming the clinical diagnosis. Determine further tactics of the patient treatment.

Answer - Diagnose is bacterial vaginosis

● congestion watery grayish discharge with an unpleasant & “fishy ” smell.
● pH lower than 4.5 very strongly acidic.
● Key cell and Gardnerella vaginalis is found out
It strongly diagnoses this patient with bacterial vaginosis.

Treatment :-
● Metronidazole
● Clindamycin
● Tinidazole

Task 7 MCQ

1) C
2) D
3) E
4) A
5) E
6) A
7) E
8) B
9) C
10) C

Task 8 -

Question 1 - Torsion of tumor pedicle: GP tactics, emergency care.

Answer :- Tumours of different histological structure, not matted together with neighboring
organs and having an expressed pedicle, are subject to twisting of the pedicle. As a rule, these
are benign and borderline tumours, but malignant can also be seen.
● Twisting can be connected with change in body possible, Physical strain,
increased intestinal peristalsis, Overfilled urinary bladder, long mobile cyst
pedicle.
● Clinically it is shown as - Sharp pain in lower stomach, accompanied by
nausea and vomiting During palpation – tension of the anterior abdomen wall,
 positive Blumberg's sign, intestinal paresis, delay of stool, less often -
diarrhea, Raise in temperature is also possible. Pale skin.
● Diagnosis :- Blood test, Urine test, Ultrasound

● Emergency care :- Such patients demand urgent operative treatment. There is

no medicine that can untwist the ovary. However, pain medications such as
narcotics may be given if the child has a lot of pain. The goal of the operation
is to untwist the ovary and Fallopian tube and restore blood flow to these
organs. This can be done using an open or laparoscopic approach.

Situational task - Patient 40 years of age, with complaints of abdominal pain and profuse
blood flow from the genital tract. The last two years of menstruation last for 14 days,
excessive, with clots, painful. There are 2 pregnancies that resulted in involuntary
miscarriages.In mirror and bimanual studies: a myomatous node with a diameter of 3
cm, on a thin leg, hangs from the canal of the cervix. The uterus is slightly higher than
normal, slightly painful. Apps on both sides are undefined. The excretion of blood, in
large numbers. . Establish preliminary diagnosis. Make a plan of the further examination
of the patient.

Answer -

Disturbing bleeding patterns with clot. Painful.

Bimanual examination shows myomatous nodes hanging from the canal of cervix.

It makes us to diagnose submucous myoma, as they are located beneath the endometrium.
These tumors grow into the uterine cavity, maintaining attachment to the uterus by a
pedicle. The pedunculated myomas may protrude to or through the cervical os. These
tumors are often associated with an abnormality of the overlying endometrium

● For accurate diagnosis we can do blood test (to assess the degree of loss and
account of replacement) ,
● endometrial biopsy or separately uterine curettage,
● ultrasonography accurately assesses uterine dimension, myoma location, interval of
growth

For treatment:

Medical treatment is a temporary treatment, ideally used for patients who are close to
menopause,

But in this case doctor should do

Operation: untwisting of the nodes protruding into the cervix. Then further monitoring.