CASE 1

JY, a 17yo, G1P0, single, Roman Catholic from Bacolod City, admitted last July 31, 2020 due to profuse vaginal bleeding.

Four months ago, JY noted occasional vaginal spotting. Vaginal spotting was associated with increasing abdominal girth. No
other symptoms noted. Two months ago, minimal intermenstrual bleeding persisted still soaking 2 pads/day. A palpable
abdominal mass between the symphysis pubis and the umbilicus was noted without other signs and symptoms. One month ago,
she had episodes of nausea and vomiting sometimes not relieved with conservative treatment. There are occasions when her
blood pressure would reach 150/90, but no consult was done. A day before she was admitted, profuse vaginal bleeding was
noted with passing out of vesicular tissues. It is now associated with nausea and pallor.

She had childhood diseases like measles and chickenpox. She is not diabetic, nor hypertensive, and non-asthmatic. Her
father is hypertensive and asthmatic, while her mother was diagnosed of having ovarian cancer.
The patient is non-smoker, alcoholic drinker, with no known food and drug allergies, and a highschool graduate.

LMP: March 27, 2020

Menarche: 13yo, regular, lasting for 5 days, soaking 1-2 pads/day
Coitarche: 17yo with 1 sexual partner. She has no history of having pap smear tests and no family planning method known.

On Examination:
Patient was noted to have abdominal pain on the hypogastric region, no vomiting, and claimed to have mild diarrheic
stools but no hematochezia. There is no frequency, no hematuria, nor dysuria noted.
BP: 90/60 CR: 70bpm RR: 20cpm Temp: 36.8C
Palms were warm and dry. Symmetric chest expansion with clear breath sounds. Adynamic precordium, no murmurs,
regular rate and rhythm of the heart. Abdomen is flat with normoactive bowel sounds, tympanitic, no hepatomegaly nor
splenomegaly. There is a palpable abdominal mass at the level of the umbilicus. Bipedal edema noted. She is alert,
cooperative, coherent and oriented. Nystagmus is noted. She has intact cranial nerves. On speculum exam, cervix was
smooth, pinkish without lesions and 1cm open. Internal examination was done and corpus is noted to be 2 fingerbreadths
above the umbilicus and fixed. There is no adnexal masses nor tenderness noted.
On admission laboratory results:
CBC Hct - 29.9
Hgb - 90.4
Leukocytes- 5.5
Platelets - 384
MCV 85.1

Ultrasound Findings: Multicystic vesicular intrauterine mass with increased vascularity. No associated fetal parts.
Bilateral theca lutein cysts.
Pregnancy Test: Negative