TC) ‘A 38-yearaldwoman cams tothe otce de onew-onsel pan wih intercourse. The pater ha bana aelatonsip wih a male pate fr the pas 6 morte ands sing conde er conracepton. Fer the past mori, shohas ha worsenng hsparenis and vapnal rns, ich has mace ert sens att este ro hanges ini. She has had fee parrers an has otha his pobier before. The enna hat no poston petro abrrmal aga dsearge Fan nists ites fase wh infest duet 48 ‘mosaics. Val ins re noma. Bibel bess ae aonic. On pelvic examin, he vale ate pal and, ade crs protudes| ‘fomthe ctor nood. Theres otenfemess fo papaion overt peeneum. Th vgs has neal estion and age, miter ‘enor mass is papated. Peprancy testis egae, Pvc uvesundrereak 3m sd adreral maes. Which fhe lowing the most ey elegy this patents reseition? ‘A. Chvomosame edits vara ell eneion 8. Conplorcofecton of punt, pmicobal id ©. Entoretal gandsard ona win fe ory . Boles) fl aom tS OD. Estrogen secreting sex co-sroral mer i ee : OF serous epnetal ovarian tuner ey 6 “sone ster sx strate =) Okun see emienere el eel ‘A 38-yearaldwoman cams tothe otce de onew-onsel pan wih intercourse. The pater ha bana aelatonsip wih a male pate fr the pas 6 morte ands sing conde er conracepton. Fer the past mori, shohas ha worsenng hsparenis and vapnal rns, ich has mace ert sens att este ro hanges ini. She has had fee parrers an has otha his pobier before. The enna hat no poston petro abrrmal aga dsearge Fan nists ites fase wh infest duet 48 ‘mosaics. Val ins re noma. Bibel bess ae aonic. On pelvic examin, he vale ate pal and, ade crs protudes| ‘fomthe ctor nood. Theres otenfemess fo papaion overt peeneum. Th vgs has neal estion and age, miter ‘enor mass is papated. Peprancy testis egae, Pvc uvesundrereak 3m sd adreral maes. Which fhe lowing the most ey elegy this patents reseition? 1. Chromosome nits ovaran fil eet (1%) 8. Conplorcofecton of punt plot i () ©. Entoretal iandsard stoma win fe ovary (9) . srogen secreting ex cou-sromal tuer (18) eae ‘eres epeta cvarian tuna (3) V6 Tessier sereng ser crt svar mee (65%)a Seroteya une pammemn | > S08 eteawnne | Fsoscne ~ Raion veces cane | sen rg rie) ined mm 1 Gtoomensy + Oignerone 2 ‘Management |» Suigeyy (tumor staging) > ‘Ths pee reg oe rena fn hn) ale awe mtr ox a 81 Sage La tumor atxosenesering cordate tuna Sao eye sn e essence he : a eee ; ‘nee ne semen en ng DR + Ripon inion Tesoszone as ayaa tet mehr ses festa heOEMA 28 Scns = pba tor eues ymca erably voce depen ane eesedmune as 2 + Sorsofesrogendefeleny:Testostene nhs hypotonic GnRH ae tutay FSH ease, rst mow esronen. zs ‘Thee aes na are We thy swaaprlatpN ajoweuie lamers = scavteg cer ny sagrots tan cary cares maapeenireses ese These wheat tate nay requre aktoralchemateapya “This pants carmen (9, ctv peta tom he lal hod) and large adnexal mas ar mos hay du to a Srat-Leye el tumor, atestostrone-seeatng Sx cord-stromal tum. Sel 27 Lay ces ae rormaly foundin he ees but cn devel he ‘vas and produce eseserne pricy ater malgraeonsfomaton and cel pofeation. The tesosteoe exces resus in there {estes one aso en th ture, eng + Rapisonsetvinizaton.Tessirone and dysstesoseone fect ert saves resutng nsteremegay, 2 cen in this abet Retr esres may nee ale pater bterpra bang voce decpanng and nceared muse ase + Sirs of estrogen defclney-Tetstrenenhbtshyptaanic rR and pautary FSHILH less, restr nl serge Therefore patents may devecp eas arty whore tcp, sparen, nd cigomenote3 ‘Secale cas ar ypcay diagnosed at an cary cancer sige, and management ices supical removal, Those wth metasae dsease may requreastoralchemotoapy, (note A) Tuner sycome (45 0 causes comosome made eran all depen, eaten prmary owen auicercy Rese tens hve cigs of eeegen dfiency eg, dyspareuna vapna atopy) hover they have ro associated wlzston (clergy) 0° ‘ere mass, mang ths Sogross ure 8 (Chelee B) Aube ovarian bscssisacorsoxcalecton cf pulent palymicobial Mud hat can present as aconplox adnexal mass. The : abscess vba manfests ctl th fever, and patents rave ro associ wzaton. “ (role) Encontonas (ender lands and soma win Ie ort) can present a come coxa masees Pater wih oa ndonstosis may have dyspareunia bute asocited vrlzatenoestogn eine. 2 (meee 0) Grandoe cel tuners esgen sete coe tun) pest ge cpl ovatin masses. neat oe eI tng, hse wi a granuoea el unor hae sg teva esrgen eg beast ences and naa vagal gate = {hoiee E) Lace detysoganse sexing gu clara og dygerinemas) cause sit adhotl masses Dyagericomas ay sctle 26 cG andesvogen bt nat seeone, malin hs agri ky (Ghoiee F) Seros evil crrian unos ae 3 common pect ovaan cancer ese pales have asocsted viition|feahise ater sscetsuemn tne tiny ncn + Rapiconsetvisteaton.Tesostzone and anyeestsseee aac perhetal sss, esung mn eteromegaly, 2 een 01h pent Aton eas may clude male-patla (btenpoal balding, voce dopenngané neared msde ass, + Serer anmogandefiney”Tetstcneahbtshypatnaanic Gran puta FSH ease est lw esrogen Thee parts may devtp bess aot woven atopy, semen end clganenarea ‘Serol-Leyd cas re pcaly dsgosedatan ear cancer sge and raragement inches supealremoil. Those wth meas dsease nay eure aasteralchemoaapy (Ghote A) Tuer synsrome (35 0 cases cromosomemesited vara ice een, esutrgn pmarcwrian sticercy These tenis have sigs of estogen ficiency eg dyspreuns vagal aophy) however they haven associ ization (elec) ‘scretal mass, mais Gagnoss une (hole B) Abo ovarian sbzcessisa cones collection of puient polmicobial Mi hat can present aconpes aera mass. The stacey manos ntl ih ver, and patents rave na esosced wan yes a 2 {eho c)Encoretionasenéoneia gts nso wiht ra) can reset ak onsen area masses. Paes th ae crdometnis nay hve hapten bln associated wlan oregon Gee. : (Ghotee 0) crznuos cal ura estogen secreting sx cag-svonal ne) mesentery, cmp ovaan ses coms DN : oe ase we gars cellar have srs oferta estoen eg esters) ans naa vagal nan 2 (Choi &) Lacte derydiognase- sexing gem celta’ ep, dseemioamas) caus sli adnrlnases. Dyegemconas ay sce 3 ROG ansesrogen but atesoserone, making ths agross ie » (eneiceF Secus epnelal ean trers ate acanmon ype of ran cancer, Rese palesnave no asocted waten = Educator abject Seok Lyd caltuna asx corsa tunes atesoeee scan ovata n,n can have lato elena) and sigs of extagen defieny eg, breathy, wulvvagna opt).‘Serotec ar tpcaly cisanosed at an cary cancer sige, and maragement ices sual removal, Those wth metastatic cease nat requteaktoralchemoteapy (hole A) Tuer synarome a x) ene eromosome mest verano deplete, sutra rmanyovanannattoercy Trees ates hve sins of escozen dfieney eg dyspareuna vagina atopy) hove they have re associate wizatlon (ele) ‘ihecal mass, making ths agro url (helen Abe ovarian coscessicaconpoccaecton cpio. palymisota Mud hat can reson 3c acomplor adnexal mass. The abscess ypcaly mantess antl th fever. and patents have ro associated zation (rote €) Enconctionas(ndemetial lands and oma wn be ovary) can presen a come ronal masts. Patents with ‘ndonetiesis nay have dyspareunia but asoited wlzaten or esvoge eo, (note D) creas cel tuners esogen sce sx coxd-tcal tunis) pest as lage cx ovatn masses. cota oe stent thos win agrnuoes cal iar have gs steed srgen eg bresetenrese) ana nema vag ngon > (rote) Lace deryarogenase-seteng em caters ep, dysgericamas) cause sll adnoalmasses.Dysgemicomas may sale on CG and esvogen bt not steeone, making his agri iy, : (CroieeF) Seraus epihela ovaan unas ae a comman ypecrovaan cancer ese patents havea asscated ization a ‘Eéueations objective: 2 ‘A Seto Leys celta sexcord-sbemal tur is tesoserone-secing ovine. Patents an have ileon ep, lire) = andsigs of estogen detiseny eg, beas atopy vuvovagna opty). = References = 1 Feity panrg ranagern! nd oleic ucomes 2 20 yer- cd pert wih Sat Leydig cal amor ofthe nay a caseep and + Cincopshcegc emis of ori Ses Ley ol osEa La COE) ‘A 25yef nora woman comes tote ofc eto feNe and ower sacralback pan The pan has wers2ned over hepa ea, ntortios a few ay before merstutin, and improves moderato tows he en fer pid. bapoen el minimal mises the pan ‘She hs fever sonormslagnal decarge The att ha enna manoganueelsonehp wh Per boyena fhe pas eae. For the fst 25 years hey used codons for cortaceton she began taking ral caracerves 6 rnths ago, Her temperate 372 (8 $F) sree peanse'= 12070 mmHg Exarnaton shows lndemear inthe porter vagal for decenced tre mobi and tack of tie ueosarallganents. Ne ainexal masses ae palpated Une ACE Snegave Henogobh 12 gular lekoote courts 820M “Transvaginal uvacoud sows oma pee ata, Which the folowing sthe most appetites tester hs ater? OA CTecanetine seve © Entomera money © 6 Hyseosalpngearan O. teeacscoy Qe sommoniesa “he flonngvonete apples athe nit? tems. Te rs te St mat be anaweedin Saguitar Che yu clk Proceed to Net em, you lak ae oad change an ane ‘A 2.yaol nlc woman coms tote ofce sto pee and overeat ack pan The pan has rst over eat yar ntortios afew ay belremerstuatin, and improves mode ova the er fet pid. lbpron ely mney cashes the pan ‘She hs fever sonormslagnal decarge The att ha enna manoganueelsonehp wh Per boyena fhe pas eae. For the fest 25 years hey used cononsforcortaceson she began taking ral canacerves® rants 2g0. Her temperate 72 (8 8 tie ueosarallganents. Ne ainexal masses ae palpated Une ACE Snegave Henogobh 12 gular lekoote courts 820M “ranvagal utasound sows norma pei ante Which fhe folowing sthe most apport dios testo hs ater? A CT scan ete pets (18%) 1 Enaematral pop (6%) ©. Hytrosiingogra 0) YB. Laearescony (0) E Seumcet25(0%)6) se Gg + Need for geintve diagnose? 1 Hote of ft? {Cancer for matgnancy or acnexal mass?— amelie san extagen depend condita ects reprcicive-age women. Era eronetil acs and som cae pan due twcytenemomage and accunustng txoss. Pate canbe asyrtanatc of deve asmenames, dspacuna, an even pave pal that worsens belo the onset of menses. Typical examination fangs ae endeess ofthe ecte-vagina ate, endeess with movement of he wars and thckaing oth ueosaral gare assed by enor mplants on he eco vapnal sept ei ereencum, at nd poser cle sac an rosa igamers.Negatve boo eng and err uvasoundexclade cher eos of ror peic pin ‘Tresmert vin nostra ant-nfammatory drugs ancl ora contraceptives cane inate emia in pater wth suspects ncorsties. Laparoscopy is iristod ata falure of empl therapy, 2 nhs tent. Laprescopy alow fr rec vision, Hons, andrenoal of encomeot sions Unless estogerc sation i eneressed sympa evel rem ith erat of fenaoratioss. Dette vearertin wen uno ave competed cnnearng wath treo ardcaparecy (Ghote A) CT scan maybe peermedia search er oer elise tronic pele pan bts et the sty ocho patent wth hy spepecedendometnors, anna aia delineate edoratal pant tom ter of tase a (Choiee 8) Ercortial toss can diagnose ondometal ancr patets wih abronmal sine beeing of osimenopsvsa edna. is ot inacatedin pants wih pvc an wo dorathave atnorralleedna (hole ¢) Anystrsaingogram sa diagnos testa checkin shape ofte ue cvty and faloian ube Fteny is commen etomed asa par ofa neti resize, netfor pve an (Chote &) Athough vernen wth eodometods an have an evtedCA-125 vel CA-125 nota late agnose tetfor he conten due to pow serenity and spect. CA-125 is used to mesg a paseranopausal aera mass frrekofmaignarcy ard has no tyn 3 ent wih pe pain Educational objective: \azaoscony wih wsutzaton and tesy of enometilimplanisthe ol deine Way o agnose romeo. Its iccated won novel antirfiammatory cups andhomona cenracepme erapy fave fae ReterneoeOu ee= 4 > KC) > oF A B. Endoretal ence (@H) YO 6. erty 774) 1. Ostecperei (1%) Pare ova ae (2%) F Recurantcamiage 2%)Giana SY Ma Endometriosis Pathogererie |» dope pinisionl enor gna oy + oysreraenea Cintcatenuree | + Chen pave pan + nrg Physical amination | {1 Recioagal septum, postr cuLdeea, eros! game te oties : 7 eal oa cacao, NSAIDS) : lana + Supestiesecten oa NSAlDe = nena Bas = Intra scommani the Sale resertng symptom cfendomeions, uNchs pesetn ne quar a paterts win ienty. Cyc a ‘accumsan cect oof erortape and adhesion can dtr pbc anatomy andimpar fet by cbatucing ove reese spn = {ery The presence oan endemetimsoraan endometriosis ysis so aspoated wih pated ovatan ncn. Lapsescope secon 5 fendoretiess, especial vari endometionas, moves concern ts (hein A) Anemia may ocr eto increasd blond ss romheavymerces fom consons at stor he wenne cay e,somyomata, averenyoss). Endorses Coes rot cause increased DesaGiana SY MO Inter scrmeniy the sale resertngsymetom ef endomercse,utich preset inne quate of al pets whiney. Orc _accumustion of ecepc os ofhemomtape and adhesions an stor pei arty and mp fery by csrucng coy reeae oem fem. Te presence ofan endemetiomsvaten andanetrcss js) so assocsied wi nparedavaan ncn. Lapaescopeesecan fendomeress,espcaly varan endometonas, proves concern rs (rete A) Anemia may occur ae tncteased Boat ss om heavy mers Hom concn ha star he zone cae (6, emma serene). Eometresscoes pat cause ceased berg (hcieeB) Enometil ance may rest fom conic arowtion epee ovarian sete) du fo ncppoted agen simon of IMeerdomenum. Athowh erconeross is estogenessorsive I symplons esl Yom cee shedding of endo impant ae an encppored ula fhe line endometium. (roies Dande osteopross Sequel et rypeestogers, wich can oct ae rata encase Premtinecvaran fare (age “#0, af gnatznopr teeasngtermare agent Rerapy. Endomeross does ft hence cua esogen Conertiaons ad des Pa caus prematre verano (rete F) Recutet mscarrage can occur a to were cay aboamales (2, awline esis, congental nonales, 192 submucous fred) Erdonetoss ects nl cutsde he ues. {reiee 6) Secondary amenornea s deine 2s cessaten af revo estalshad menses fo/93 mth aca as Hom cel pmutny ‘denon hypstaani as yscon ox parperal (tau acess, poste ovatn syns cauees. Endomatrons dosnt tere neal menetual ec Eduestona objective: Peters win endomenoss ae aan nceased ko wertyResacon of endonetios proves cncepton ies 1 Dierences crates among C00 women wt endomoss hase on exert of dsease +A prcpecve cohort sty oferdometioi and teaver’ fifriyaed (ree A) nema may occur ae tncteased Boat ess emneavy menses tom ears ha str e anne cag 6, arya, a ‘aseranyes). Emre coes pat cause ceased berg eI (hcieeB) Enometil ance may rst fom cron arowtion epee ovr sete) du fo ncppoeed aogen simon of : Imeerdomenam. town erconenoss i estogenessorsve I symgoms esi tom cee shedang of endo impant ae an a enzppored ula fhe line enometium. 3 (roies D and} osteopross i Sequel ctrypeestogarsm, wich can oct ae rata encase premtnecvaran fare (age ie -<é0), af gnatznopn reeasngteraneagonst Reapy. Endomeross does thence can esogenConetaons ad 8s a cause prematre ovaran alu. 2 (rote F) Recuter mscarrage can occ de to werme cay Sonoma (eg, awlie aonesios,cengental anonales, pe a ‘iomucous fra), Erdonetoss ets on cursde neues = (hcie 6) Secondary aneorbes 2 defined ocean fret ecablahed menses for*9 rth and can ai fom cera (putry = ‘cena Hypa ats secon) ox papel (eta aceon, poste avatan syne caves, Enomatons dosnt 2 ‘tere neal manual eee 8 Eduestons objective: : Peters win endomenoss ae aan nceased sk wry. Resacton a endonetios proves cncepton ies a References a «A prospect coho sy otencometioss and soseqient sf fry = COstercs 8 Gmeeony _Ferale Repettte System &Sreast_ Endoretos's— Pian EJ - A S ‘At yaraldwoman, rida? par 1, 10 weeks gestan comes oe cfefr ain prenatal vt. The pant has had ne vagiad ‘eed or ramping, He fs preorarcy was uncomlsed ard ended wth aterm sparaneos vagal eivey Sh has no cre med condos andhas ad o previous sues. The patie akes 3 daly real viarin ae des note sce, acho ert rugs. Bcd pressures 12070 inHg and puse EBman.BM24 gin? The line nals papad nove ne pubesyreyss. Peculascund ‘Stora 2 vale rauisne gests, singe nda placer end ah etn mererane at mis he placenta st aGCdeqree ange Ths stem athighest ee ormch of flewngcomplesbons? ‘A Conones ins OR comenangemere . Pacona preva © Tuinvanstison snarea ‘At yaraldwoman, rida? par 1, 10 weeks gestan comes oe cfefr ain prenatal vt. The pant has had ne vagiad ‘eed or ramping, He fs preorarcy was uncomlsed ard ended wth aterm sparaneos vagal eivey Sh has no cre med condos andhas ad o previous sues. The patie akes 3 daly real viarin ae des note sce, acho ert rugs. Bcd pressures 12070 inHg and puse EBman.BM24 gin? The line nals papad nove ne pubesyreyss. Peculascund ‘Stora 2 vale rauisne gests, singe nda placer end ah etn mererane at mis he placenta st aGCdeqree ange Ths stem athighest ee ormch of flewngcomplesbons? ‘A Cononea wins (2) 5. Cord entangner (2%) 6. Pacer aces 28) . Paco preva) .Twmauin vansison syrctome (8) note Benticane ‘Twin-twin transfusion syndrome (TTTS) Gg CO fe]a “umn gst a ead akon egrancy olcatens Ts k's ater sae bated one honey (umber ct carts) ar amon ante tant as) fhe get. Tha patent has menace amnae wne(! pace 2 awit ‘Sess 2entyos 3 ge paca. anata ier membrane oroosed 2 antes ht mets Me paca 3 990- egre angle CT ="). eaten uo appear to have a snl lace, he base shape oftheintetvin merrane disinuihes beeen 3 rmoracheene (1 47 ana used deraranc (aba "gestation ‘Monocherionie wins aa ck win-win wanstusion sydreme (TTT. 3 complcaton thet can est hear fal and etareonais ‘moratynbot ns. In TTS, unbslaned araioveneus anastomoses are preset between he shared placenta vessels tha uy he thin, Bacovse hase eraeases, Bod tam te panna anaes (gh estanceessie) of ane hn (one sures the acral vers ow estancepresi ote ane wn feape). The Sung food aay fom fe dover bn causes rem et eats torenal aur, lgpysranner, lw cuputhear lure ana eal growth reeicton In conast he chung ceo nade recipes in ‘causes pen, wich ads to coynarmos,carmeaay, igh-upithear ae andes eis. Eth ns ea kr ‘id TTTS is expcany managed wih sol vrassurd to eat for wasn nal eabres. Moderate o-sovee casos ae West wih Ines conan fh piacental arasoroses (holes Aand 8) inrenceyote in, lcereaton ype is detemned by ting the wining. Twining haces chery ater friatien| Yelésadchoronc dametc gesatenIncontas he neorplte don fe, fn) hat canlead © cniohes wns Ox erin rm aque an enamel sy (hole B) Encoretilataion sa procedure hal destroys ard scars he endareum, I srot used as eatmet or PNB because ican prevertuteeendometal evauten and cbc nsignancy, (Ghoies and Di hspaerthas aroma TVUS ot endonetial iosy, a progest-certanng inva ere canbe place ope {he endoretal ning ie he core ezrogen therapy Inconast tbe enol cpa shows pears ot cancer he patent would aque ystreiy win baal salpngo costar (Chole €) Yaar esrozen used x vaovagral aon: does ot teat at ashes. inion, shouldnt used ntl pers have called the aS evataion ‘Education objective: Patents wth posrneroausleedng require eatin fr endmetialcance with ier atarsaginalvrascurd (TWUS) rence ‘egy. In wan wha nay undergo 2 7NUS. han wh an dren equa odin evluton In cntast waren ih an naan >¢ mm equ anendometiat opsCmensetnas BY Mt be -osmenepsusl women shad have arin erdonatum TVS i easonable est tp evluston as predic of pana and iret ‘smvasve or ucamiorene as an enfomenal cps). men wh an enometnim nm reqire re are evaunion contest hose ‘than nortan taqute an endomet cpey (hots B) Ercortial stiaton 2 procedure al estoy ard scare ederetum, Hot used seamen or PB because ican revere fitreendoner evaluon ard obsaure rainy (hoten © and) hi ptt has a namalTVUS or enone ips, a progestin cota navi dere cane placed to poet the exorata ining whi she cores esrogn therapy Inconras fhe enometlDops shows peas of ance patent woul reve hytretomy whi calngo oohorecemy (Chole ) Vagraesrogen utes vaovagnl arepny: abe ota hat ates acaton shone vans paerts have lets the PE eval. Educational objective: store win poerneopaicl Hssdng require eats fr enon cancer whether stansvagia rassind(TVUS) recone ese. n women ho nay undergo a TUS. those whan ener 4mm requ ne adcinal luton. Incnast. wore ith an endtum > mm equ sn endometia ogsy References + Imesgaien of women th psmonpaical erie Hering: ical pace recommender + ACOS commit pinion No. 7 suman hee ot ansvagnal rsanagrapy in evitng he endonetim oren th COsteics 8 Gmeeony Female Repeuctte System & Breast Encore cancerTC) ‘A 10yea-ald woman, rida * par 0, comes oe emergency department for even of gh sided dominal pain and eer forthe past ays, Tre pan has pesressed vere st ew hours rds nowurbearable. The patert has had nes ate, nausea and acres rnoveringcr darhea. She has ha some rareaflcentariors bt vagal eedngo dicharge. The Fatt has had ro reat core anais.a 2 ace gesatony date thats Sue, egrets pecs. She Naso even medcal canons andhas hos o pce ‘sugeres Te pater does ot use cbaco, acto of ae dugs. Teper s 1022 (90) Head ressueis 170 mH, ard pulse |e 20mm. Theve tenders ovine nt fan, bn socominl eur or guardng. The an none. The enc = cee an8 Sree mertranes react. Tha fetal heart raana shaun ine ett. Which of efeitos ke agro or he ‘ewe appends ewe pyneciis Dezeerang ere ros sntoanritineion =) eeTC) ‘A 10yea-ald woman, rida * par 0, comes oe emergency department for even of gh sided dominal pain and eer forthe past ays, Tre pan has pesressed vere st ew hours rds nowurbearable. The patert has had nes ate, nausea and acres rnoveringcr darhea. She has ha some rareaflcentariors bt vagal eedngo dicharge. The Fatt has had ro reat core anais.a 2 ace gesatony date thats Sue, egrets pecs. She Naso even medcal canons andhas hos o pce ‘sugeres Te pater does ot use cbaco, acto of ae dugs. Teper s 1022 (90) Head ressueis 170 mH, ard pulse |e 20mm. Theve tenders ovine nt fan, bn socominl eur or guardng. The an none. The enc = cee an8 Sree mertranes react. Tha fetal heart raana shaun ine ett. Which of efeitos ke agro or he ‘ewe appends ewe pyneciis Dezeerang ere ros sntoanritineion =) eeres Aas To Fash co & Zoom out Q 200m InEa La COE) a ‘A 28-yard nliparous woman beng eva one canes othe ofce duo ear vail dachage fr opus dys. The patent anche pao have rercouse evry ote yard have been tng fo corcavefer he past 7 months. Merstwal yces ecu vey 29 ays Wit 4darsof fw. Last week she tock erin ras troat The falet has norealseues anda ado sugeres. Shakes a (ay rental amin Pat examination shows car mis ati cerveal Yeh flowing ise moe ea enantio fe Serial vines ia canes mu ag “ cama TietemeniasEa La COE) a ‘A 28-yard nliparous woman beng eva one canes othe ofce duo ear vail dachage fr opus dys. The patent anche pao have rercouse evry ote yard have been tng fo corcavefer he past 7 months. Merstwal yces ecu vey 29 ays Wit 4darsof fw. Last week she tock erin ras troat The falet has norealseues anda ado sugeres. Shakes a (ay rental amin Pat examination shows car mis ati cerveal Yeh flowing ise moe ea enantio fe Serial vines ia canes mu ag “ cama Tietemenias6) se Gg = a ‘A 28-yard nliparous woman beng eva one canes othe ofce duo ear vail dachage fr opus dys. The patent anche pao have rercouse evry ote yard have been tng fo corcavefer he past 7 months. Merstwal yces ecu vey 29 ays Wit 4darsof fw. Last week she tock erin ras troat The falet has norealseues anda ado sugeres. Shakes a (ay rental amin Pat examination shows car mis ati cerveal Yeh flowing ise moe ea enantio fe paon eon 2 A Bid 08) : oe 2 ©. Centeal mucus plug (268%) aA 2 camden) * ¥ — E. Oudation (56%) as Tice) oa Teese fetes = as Physiology ofthe forte windowPhysiology of the fertile os -020@M @a- onacy Sacininy esr Ovon cup Regesen Cap Fertile window Bake eee-welgaeesisese Bosal]Q zoomin GQ zeomort recat | ABs ToNew Cat | Eesang Cars = ry ryeed a ruaion mats the waneson om the fcr phase fthemerabual cele he Meal phase Ti aca mivaytcugh he worse ye anais preceaedy an LHsurge, he hamane ypealy Geleedy comma ovation Ms. Coupes tng 6 cancene a aero ‘schedule ntcourse mnadately oto ovation whe LH measurements by menting pysokgc fas such as cecal mucus and basal boo temperature {Gerda mucus seroton seo olan fate aa shase) Mcseass quar arcane eave by patent svagna dsharge “This mucsis cleat, thn ncosistecy and desrbed smlar appearance oan uncooked eo ws is ougtt flat sperm ‘anspor the urs forcencepten.Ater bon occur, the mucus becomes hick and less espa to spe. (note A) Bacal vagiosi pial causes aie whe daxnage win an cdo rate han car cen mus treat (noes €) crv mucus iu serves a bari ascending econ dng peprancy. This bo, ee yellowish hex MICU iY Sredbeto edna ater (Chole ) Chama cers can pase ns mucpunsert cence schsige and afb center an clear sane! seereons. (rete F) Tacnoeniss causes ylow ren mdecrous ascnaige rae an ea ceva ms Eduction objective: Cervis muus i! oro tion poise, clear in, and eonespod wh an LH surge Th physio ing nt an inca ot References + Tine wercouse couples nyt concen Cates Gynecdogy Female Repoaine Sytem Arestt__Ovuaton sane Sree eecyes os -A22,yaold wan, ida pra 1,40 wees gestaon aati oe Resta duo sporarcous rupture of manrants and eg, ‘anf cnacions. Ths prepranyhas teen unonled, but hers prograrcy rested nan operate vaginal delve er aren reassure ft sizus. The patert has no erorc medical endo andr per ergeris, Her dail cervical exarinatons sce adision 2 : ; = i i 5 ; 3 -3 — Tine from admin (ous) = Ccurereerpwctue 272 (97) Bond esses 12070 nig and pus EDM. Fetal a te Nong aap and = eec se Gg Eagan za es Tira for smi hous) ee Sm ca oa sec ee gh maa eg es = a : oo) “te Oem a 0. gwen ey 2 ac se Gg i 2 conse shaccensemaaaaypseny = || cuevenmnensr2 6607 tas pemuei Te wis atic ari Fenn cay Sm Oe cw ae a a eae i cease “EL |v = setrnsones ey ‘E ep eereeeeaeererest 2 0. create ey 2 non aman) oo 3% 5 secs oernorz020 =o W sacra6) se Gg Davon of er (on) 7 8 8 90 = i “Time from admission (hours) “ne tet stage ot aterbapns tne onset ep conacton ana urticaria em) ene aston The et tag aes into pases + thet phase (8 cm, whan he cones sul and has no dined expectd at of conve change + me aeve phase 210 om) en ne crv ts py wn 2 nam pegs 24 em every Zhours Vines evaluang is patents ber eure, note that ater phase hada ate of 3c m6 house, took Shouse om 39cm) ‘Aer elering he aces 2 cr the pet’ ceviche cise cr took 2 rs fo ie fm fo Ber) consset wh normala he at stage ater Dep wl i onset ear nachos rales ut crate "0G carve atone ws sage vce into prases. + eaten phase (82m, whan he cena aes Sut nat no deed expected at cecal change + the acbve phase 210 om) en he ceva repay wth 2 norma romesson of 21cm every hours ‘nen evaluating is paterts ber cure, not that ent phas hada ate of cm m8 house, took Sous td om 38cm) [Aer etrng te ace pac (8 om the patent ceviche ies | crt tone 2 outs tot to 6 f Bem) content wth normal ae || taeeremnnn Th rus noe ne ree om. i caer re EN os 2 || satstanmyenn sets pogen mela scary evn ok fo] etcgnaun mecnarimeeapecan mnogu 78 (Choice A) Cesarean defvery is indicated for acive phase labor arest (defined as no cervical change for 24 hours with axlequate contractions or |] Siac tts comcast ng © 2 |) eroem cant) nena cng arse cavalo sat nai ber ose) is este el) er citomenranensenteganatee(tiaroronn) fencer we nena 2 None, 5% |) ecient ccm nce conan eee set : (ene) Ate in ee en cp eve eres tee ce ty Mare 7 ten ash aude sana apt Gos ane TF ed en | Tetatamectan sane 2pae elke ehe Oem anteater 0) Nealibe pagent || estore? am, P un uae aopesonnaeurpnaena a ns ae apes oc 2 | pawns «+ Theratual hear of he parma st 92 tabores ee ‘A soyeal onan ait pans rn a icin tl of ih ki. Th pet Cramer al toaliyseecory nun ota rma aan ce The eae we oped eran 3038 Crowsloxeabn tt narpted noe ined ohevars her bnognteleas 6894. Apaceef ice ‘erst asntted rs 6M maa range fa pane hae veda an og ange te Teper 365610137) rere 080 1m, 130m anepafre we 75. Cra arate vas ‘syerin recaps. Ter cea ray Tes earns tre Thewroa i kes note lonrg nes yon te dao ne et? 8. Oystescony ©. Ores Comoe eet 0 Att OE Revalarascnsche a -ASb-yaold woman is evaitdin the post neath ae it ut euden oe of ete nausea ad ight arpa. Te pater ‘conert 2a aborina stereo a uno’ debulking fr metasa vara cance. The proce was compat by teeong nd ‘uteralaceraon that wasrepaied rappel. nesta her heobinevel was 68 gl. A packed red ood call ‘arson ua ited TO mutes age Now M acten to rausea aap Nak pan, she has develped pan aa ang ang eV Ste Tempera 285 (10137) lod pressures 250 rn Hg, puss 30m, and esprators re Zam. Cadac exenan reveals tachycardia win weak puss. Th ngs re clear bltraly. The sn axamratonsnornal. The uineis dark res. Which he cloning woul mos ay estat the agnosis in hs patent? 1 Be ete) B. Oystecopy 2%) V7 ©. Beet Goomes st (65%) D. Alea 17) Rena lrasoons (7%) Ca OE)eer al Gael ‘Acute hamolytie tranafusion reaction + ABinconpatiny + Inravasclrheohis Ctiicatings | Fever cis rypotnsen + Hemera ak pe Patnogenase ~ Petivedeect Coon tat + Hori en, 1LOH, ret iin + ck real re See ee ee eee eet eee ‘are ut perl ata eacon ave to vanstsen tmsrateed ood eg, ABO ncompaay). The mos conmonetioy ra ea (69, patent adeiision, ee ae eee te eee ee eT ‘eed cl destin (w inravaseurhemalyi) wich aso occ henegobin Bul Pe Wey, ea Acne subsequent acute eal falure. Tee, ngs tat ase spon fer NTR nue Nan pain and dark ed wine (e, hemoglblnw) os Wal s fever tchycaria. and hyoctenson ve ilareatr eve reas) shy flown a Yansfson Patients may ao Rav2 lett lactate desrogenas eves om hens) and lseminsted inraraeeular eagulton cing ntaverous se) Diagnosis of AHTR sh postive erat Coombe wet facing artosy25, + Unistral(onmiin] pai pain a oon inthe sets rh ecu pan hata testo the igh fan + Nosistonc symone en, abue nausea) cura menses + Aonomal etre Beedg (6, mtzmensrul Deed, poston spi) ‘These featres ate augertve ofa val of patelogie causes ccjerenahea acing pec ifarmainy Seca, erdorabinst ado masses, and aene anay 69 usec siren) Pyscal xamnaon peermedia eater ese poss caves: pats ‘sth abnor examnation edge ep adneva mas, cereal etn dees) may requ adaional magna (9, elo utecound) and posse suger (oy, ascop) (rete ) oysmenarea ypcaly improves werent antarimtry as (NSAIDS eg, git) aecauseth pan fesuts rom an ‘tener repones andinceseed pesaglndn lace, Pan ht doesnot grove wi NGAIDs can be eugpesve oa sacendary cause of 25 + Unita! fonmistin) ple pain a: xen inh patents rght awe quan pin that anes tthe igh an) + Nosistonc symptoms en. abue nausea) cura menses + Aonomal ane Beetg (6, mtzmensrul Dea, poston spi) ‘These eatres ae uggesve ofa variety of pathologie causes of ysrerorhes, ning pei ifarmatoy dscae, eronetio adhe masses, and auteine anoray 3, user sternerotn) Pryseal examen pestered a eve tes passe cases, aas ‘i anol examnatnn tage ep aanexa mas, cereal en dees) may req adainamagg (a, el utesound) and posse surgery (6, asco) (rete) oysmenarea ypcaly improves wer rensttltal antarimtry as (NSAIDS) 9, gta) aecausethe pan fesuts rom an ‘tener repones andinceseed prostaglandin lace, Pan hat doesnot grove wi NGAID can be eugpesve oa sacendary cause of etal cn tne) = one Nooo ar adsegs : El Gieaonie ne a Placental abruption ca ‘+ Maternal hypertension o preeclarpsiafecampsia a 2 Abdominal aura a Riek factors | Proc placental abruption 3 + cocaine tobacco use + Sudden-onset vaginal blewding (80%) ccinieat_ | + Abdominal or back pan presentation | © High frequency, low tansy contractons + Hiypertone, tender uerus + Primary by clinical presentation Diagnosis | + utrasound (ot required tor dagnosss) toro out Placa prove; may shew raoplacenal hematoma, i ee a aaa ee Seal seer Sere ee ee aml =. em | ene eee eee 2 | Gana del anal teas expen nu ena ae oer om |e (rete B) Uisine rte assoc wn er ie suger and presets wih constr abcomna a aa eau vagal eearga CLs) WW eee re posi co afar to revoplcant Bleeing bance he laces an ie des at can cause placental etacheant and ‘vogjina bleding_ The evclaceralhemarag can cas lever abdominal arr tex ps, Hah reqencylow anpltule were cxnacsons anda fry tender ns. This pater tebscro sean poeclanpsa (eg perensen, eran report kaos fo abupten “The lng te aes fplacertaldetactmert he gether sural compton sch as daseminated intravascular conguaton (st sesefcer rane by one las ng nahypovelaml aneck tata eta smpiesons eke hypesa an pata aivery (hetee B) Uivine rte associa wih ir sine suger and presets wih costar abdominal pan and hea vagnal beeing ewever dv the rupted wus, pans fen haves of conacion pater ater hs corsacons evry 2 mutes) ands fe (helen ¢) Aretanes plceta dos net ever wth 30 mints of every of he infant and canbe dito errapmenty the cencor fae fe each Fom he ters. Ths complain is hah uke nthe sting of perature placental éetachrent 8 (hele D) Sept shockisa ree conplcaton of ndemetii.lpesets th bypcensen tchycarda ated metal satis, and fever, Tis . ‘Baten has aroma eperatire ae no systemic sinscfifeien “ (note ) Unis crs cape ecu whan te uc cord crs Rug cen ahead ae resent. aso oa wth abort beat wecngs, mabresenan (9, ech, nd an unengaged feta peseeting part Ths fess in verex poston 2 Eduestons objective: = ‘Ateipto acenae she premature separate oe laces Yo the were ees, lpeserts wen par vagal eng and aim, = tenser ans. Natenalomplestens cud hypeeleme shockarddssorinaidnravescurcoaqulston + Placartal trpton epidonoloy, ck facts and consocuences.a CLs) WW eee re posi co afar to revoplcant Bleeing bance he laces an ie des at can cause placental etacheant and ‘vogjina bleding_ The evclaceralhemarag can cas lever abdominal arr tex ps, Hah reqencylow anpltule were cxnacsons anda fry tender ns. This pater tebscro sean poeclanpsa (eg perensen, eran report kaos fo abupten “The lng te aes fplacertaldetactmert he gether sural compton sch as daseminated intravascular conguaton (st sesefcer rane by one las ng nahypovelaml aneck tata eta smpiesons eke hypesa an pata aivery (hetee B) Uivine rte associa wih ir sine suger and presets wih costar abdominal pan and hea vagnal beeing ewever dv the rupted wus, pans fen haves of conacion pater ater hs corsacons evry 2 mutes) ands fe (helen ¢) Aretanes plceta dos net ever wth 30 mints of every of he infant and canbe dito errapmenty the cencor fae fe each Fom he ters. Ths complain is hah uke nthe sting of perature placental éetachrent 8 (hele D) Sept shockisa ree conplcaton of ndemetii.lpesets th bypcensen tchycarda ated metal satis, and fever, Tis . ‘Baten has aroma eperatire ae no systemic sinscfifeien “ (note ) Unis crs cape ecu whan te uc cord crs Rug cen ahead ae resent. aso oa wth abort beat wecngs, mabresenan (9, ech, nd an unengaged feta peseeting part Ths fess in verex poston 2 Eduestons objective: = ‘Ateipto acenae she premature separate oe laces Yo the were ees, lpeserts wen par vagal eng and aim, = tenser ans. Natenalomplestens cud hypeeleme shockarddssorinaidnravescurcoaqulston + Placartal trpton epidonoloy, ck facts and consocuences.ouwons @ 2eomin Q Zoom oat Reset HY Ass ToNew Card | Cesing Cart= BS Ow vege @ zoom Gl zomon (Seat Ai Toor Ga | Ezy CrCimaonie na anupten “henge he area of lacertal detache he greater he isk or ateralconpcators sch 2s dsseminated invavascularcosgution (cto teae cer eensed y deed leeing) nalypovolamia sack: Petal csietons ce hypenia an peterm calvery (Ghote B) Uisine rte is aeeocited wih or sine suger and presets wh costar abéomina pan ad eau viral lena However cue othe rupted wens, gan een have bs feta pate (ean eoruacns evry 2 mes ands aa (hole €) Areane lacerta does not lve ith 30 mints of evry of teint and canbe de to entapmenty the cen or facto cach Yom me uns. THs canpcaton sig unk in he stg 2 pematwe placental clare (GhoieeD) Sept socks ee conplcaton of endometiis.ieesets ith hyosienson tchyearsa aed reval satus,ansferer. Tis stan has aroma lerpestire and ng seme sonacfinfeston (Chote) Unbical cr apse occurs who te bial crd vrs Bruch fe ceri ahead of he presenting tl pat. tis assocted wi abnor etal heart racing, mabresettion (eed, nian unengaed feta pesertng part. Thsfeusisinvetex esrtxon Eduestiona objective: ‘Abruto piacere the senate separation of ie aceta fom the ere eecia,presents wth pan agra edng anda, tenderers, Matenal cmpleates incu hrolericshockard decent ntavecurcoaulion Reterneos COsterics 8 Greeony Pegraney.Chicoth &Puepertm — Areparum Beinga CLs) a |AS8-yarsldwoman comes tothe oc fo evduston of postmenopausal beeig. The patent tal had pest cotalbleding ony butilhas become mere feqvert expt he se coer eco aphal bicants and ostuiers. Forte las month te paterthas hd Say ‘aga potng ands begining te have pain wthinercouse. Unsl6 mans go, she had et ben sonal aie 10 yeas. Theat asad no ouneheath ca snce the neh chien ove 20 yes ago. She srk agar of ogres ay. Ble 20 kpM# The ‘age appar apne win mana gation anda -cm uct son ne upped ct pester wal. Theres amadocus wate oschage ine vapna. Numerous squares piel cal wth release seen ont mount micescopy, Ptassm coi est sngaive. Pic urasond shows an artevred ars ith a3-nmendemetil stipe, Which othe folowna she Bet next ‘Sep in management fis sen? Entomsra onsy (ra mevonszce Tope crtecseads anal per woeer el oni |AS8-yarsldwoman comes tothe oc fo evduston of postmenopausal beeig. The patent tal had pest cotalbleding ony butilhas become mere feqvert expt he se coer eco aphal bicants and ostuiers. Forte las month te paterthas hd Say ‘aga potng ands begining te have pain wthinercouse. Unsl6 mans go, she had et ben sonal aie 10 yeas. Theat asad no ouneheath ca snce the neh chien ove 20 yes ago. She srk agar of ogres ay. Ble 20 kpM# The ‘age appar apne win mana gation anda -cm uct son ne upped ct pester wal. Theres amadocus wate oschage ine vapna. Numerous squares piel cal wth release seen ont mount micescopy, Ptassm coi est sngaive. Pic urasond shows an artevred ars ith a3-nmendemetil stipe, Which othe folowna she Bet next ‘Sep in management fis sen? ‘A Endomatal bop (46) 8. Oralmevonazl%) ©. Topical comers (1) . Vania biopsy (4%) Vaginal estegen 6) ie eel exe 5)fener do Vaginal cancer ree) iu tacor |” Huan ppllomavins nection fears | acca vee + Inter DES exposure (dear cl adenocarcinoma oni) canes] 7 N2zhel Benn inca | Nelo vagal setae + reas vagnaeson Dingle |» Vagral bansy Managerent|« Surgery chemerssaten TES = aanyeainal “This patents vagal lesdng malodorous charge ant weerted vaginal ision a concern for vaginal squomeus el carcinoma ‘sie ina features may ince ev an, unary ses ea, erature), and ul sens eg, consipabor), wich are suDgesive fmeasaic deease_ Fisk ater vagnal cancer are snr these of cervical cance andinclue shri obseeo use, persistent human panama lesen, ansage>€0. Lesions ypcaly appear 2620 Tega’ aque oe! eed he upper IM Ya pasar vag Ins pater he bestest stp in rarapenents blopsy ofthe lsion.The ops evaluates the depth of invasion ani ces and erent eteeen aga inaephelalrecps fe neimae and apna career (mua). Paterts mh ronmasve eens an be eat conserva wih tal heroy or wdelacexcsion Chole Fn carts ose weh nase sesereque an oderse cede, radia hystrectomy,vgnectony, pec hrph nade secon ender chenaradaon. (Cree A) Endontial opsy ingested ava a enone cancer in wan wi posers teu sn an endo ing 4mm on ascund Ths patent nae atin endenetum an Meteor doesnt equre Ler evalatn fr encom cancerfener do DES = ethjtbstt “This patents vagal lading malodorous ache and deerated vaginal lesion a concoing frvaglnal squamous el carcinoma ‘eset iia features may include pov an, win SMES ea, erste) and bulk sme ep, consipabn), Wich fe suDgese feasts deease_ Fisk acts fer vagina cancer are iro these of ceria cace andre ehro obseeo use, persistent human panama lesen, 2nsage>€0. Lesions ypcaly appear 2620 Tega’ aque oe! eed ine upper IM a pasar vag Ins patent he bestest stp n raranenents blopsy ofthe lsionThe ops evaluates the depth of invasion ani ces and erent beeen apna intaertealrecpsia fe, nenimasive nd ana career fe, mai). ates wih reiasve disease an be eat conserva wh tal ern ora wdelacaexcson (Chole Fn carts hase wen inasve dseasereque an oder cede (, aia hysterectomy, vgneciony, pec ph note dissection ender chenoradaton ne ee eT eet 2mm on utasund Ths patent nae athnendeetium ac ator dosnt equre Lar ealatn fr neil cancer. (hole B) Or metordaeles used neat tarts! anno, wich pcalprecens wth amaldoous vagal discharge. Tis aeré ada negate pasion yon es and na ue cls on wat ment mosey making ie dagnoss nly fh || reer oct oteoats neta extant as ih fe ers : a : ‘Sanrnen wes pence tua sonar my LIB] rococo aan eosin mano cage a || Sepecoe tour she race tose ca proc 2) ects acral squamous cel carcinoma ically reverts wth via beeing, aledros charge, and anirepular lesion, Rsk oorsincie age 280 evan ecco use and pease eran papillomas lfacten, Dagrase by tey ote lesen which detwmnes he dep ct tvaseno ayia cetSr CL 0 & ‘nh cat he besten tpn management bapey of the lesion. The ope evaluates th depth of invasion of tic cel and erent etree apna inser recs fe, nema) nd apna career le, vase). Pateres wih renevasve Osea an ‘be treat conseravel wit opal apy ora wielee exon (hole In conta hose wth ince deeasereaute an enersve cede (, aia hysterectomy, vagneiony, pee rph note dssacen ner emerson, (Ghote A) Ercoretial toss indicate eater enone cancer woren uth osinerepausateeéng ndanendometia ing 4mmon taco. The paerthasathnendoretium and therefore doesnt equ athe eahaton fr endometrial cancer (Chole 8) Ort marendanls used owoat bacteslvagnse, which Wpaly pecans wth amaledeous vagal dcharge. Tis ateré asa nezate passim hoe festa noe cls on wet eure mosey. aking ts digress nike (ete ¢) Tcl coronas ae he teabent x desquanateitanmaton vapis, wlichoten resorts wih copious waxy ‘scare. Incest ths pat. tose wih cesqvanaive arate vgrishave an fare aythesiousvapracn peli ‘raminaton anda predominance of edocs on wet out cco EE} (hole €) Vagralesrogenmerapy sinter argh vagin, wich an cause vagal beeing, maladoous discharge, and “2 ‘rspareana. However aropic apnts rarely causes Ucerae lesen ard requtes ier ealaton por estogen therapy a Educational objective: : \ooral squamous col cacnoma yal creseris wih vagina beeing, miedo discharge, and anirepular lesen, Risk aersince ape . 00_cvonic tobacco se. and perssert huran papilomavirusinfecon. Dagrosisis by tery fhe lesen whe determanes he desthcf o3 eens iS References a 1+ Suara cel catcnomafihe vagina rt histor Pestent mois ard promt ors 3 + Prmary carcinoma the vagina CObteics 8 Gynecoay Female Rapesuive Sytem KBreast_ Vagina cancer =) Okun see tmxne 2 agree ey a] “f ee ee SE] A2t yeti vmen gn pan 2.3 ve in cn agin rt pd; pl rc, To Spo U) coucnestenmntowsns recon she terntads at ood, Se fess oleh oe meer ot ign] Scrora Te tes et peta ates Cuetec fons non rele nd bette ead es Se ie vaiars cera fant wasn sat bcree oer op ecmenog ace Creer ee eee ee ee TG) em. secarneenrnn vn prtcne tne ovr ee The cnme cn edo 00h ocr beet Satpal] “ona wie ae etna fete nen naccenn ate ae? 8 ———= a 2. Cis mint anon — C. initiate sugmentation of labor SED | Go retemeeenatey is Oe partadscs cea : OF Stet ty =)che a ‘A 38,yasld woman, rida para 2, 3 weeks gestan comes oe regency dpatnor veo eg pat cartacon. The ‘eiactons began an hour ao, edt afer he paerthada ‘aus ffs. Shehashae val ledng, a fet reverent has been roa. The pent st penta vst was 6 weeks go. Shehasre known medical conden and oes not we alco, obaco, it gs. Vial gre ae ramal. Fetal heat atavaceg tous abatene ef éDmin wh mulfpleaeeermions anda declaters. Caactons ‘occur every 2 mutes on tcedypamometr Fee exaninaton sara cae fla vss wih an enemas base ne gt abu rus. Speculum exarnsten shows aoa ot lear fuldin e poser vagina. The cere Sem ted and 108 efaceé win the fetal ead {tO tabon. hich ef he folowing he best net stepin managenant oth ton”? 1A painter teats (15) 5. Cornus expectant management) (©. itt augeriton olabr 15) lv O 2. Petemncmvncrn 1%) Parte sib cars 0%) F Satta (08) oom a a = Ca OE)lite ae fa @ oh ke ee Pregnancy management in patients with HSV Prior HSV infection oN Antveal suppression Routine aging a 38 wake prenatal care Lesonprodromal symtoms ing labor oN. veorathoy crowns rae en ST RL a ee that evens ine salew open ules or erosions. stoma HSV econ can cause wena fete, wich canbe devaitr due ‘sarscare merit en scares devcoretal ey, binenes) nd olyGiesnweee MO “This part hasan active genta herpes simplex ius (HSV) infection, wich pcaly presets as pa vesicles on an erento base thateveneine salow open ules or erosions, stoma HSV nection can cause neonatal infest, wich ea be devastating due Saree meri en seaues,devcoretal ea, ners) nd oly HSV canbe veel tranamiedtarslcenaly (pay wha pmary incon however, the mostconman rue etarsmsson urn ‘aghal devery because the fess expesd to HSV curng passage treugh te ith canal Ther oftansnissonsproportoralo the aroun url sheng whichis ghee dinng pectoral =jplons and acvelesone. Theos pers whether podoral sips active pntal SV less vr (eat tor ans pate) art underg vagal dvr an reque an immed cesarean cetvery (Ghctn A) Veal HSV tara sk cease hte tain of meninane np; eee, cc mninskaon oo (Ghoies B and ¢) In conrato ts patent ndvisuas who have ahs of genta HSV but have o pros symp aie eins at ‘dvr ean uc vgn evry bacaune rata al sed ade act vr rans ee eal (Ghote 8) Fetal sci eects ae ace patents wih HSV because hey ut the fetal tn and create aprsste poral HSV, heey (choles F) Women who have ahstr of ntl HSV receive propyl ania herapy fen 2cyor, valance) fom 6 weeks petaton url deer rece the isk of ce lesions at every athe ned x cestrean every In contest ang anil therapy at every s rs have aired foc on valtapieston Serloe, tina nce a cone ol decreare the ak feo HSV wfecton Education objective: ‘Cesarean diver indicated n ween wit ate genta herpes lesions der 1 rece thers for nara herpes Sire ws References Harper single iecon ang eresrancysng oS = = Al eer a deat is HO te ot S. GUN 29pm tt ver, gut 3p 2 et ren cae ra er ml eV Th po eho gl BD recn onc onc mores etc acturm r et2 perme ened 2 wee rer bo rs cae a Seeman | ces tne tas srenann mrpants eestor, Tepaet sro et nol caben opi arpa. Heo en cae eee ee eee ee ee eee ee FET) Saoainmen. ch cba they ebro up rimspent etree? a Oe ezaaam 13 © ©. Feta monet sing = 0, ay cet EE | Ge reentry =)a CLs) 2 Pan caso freee een ‘ADT yea-sld woman, rida para 2, 14 weeks gestan comes oe cfe fr ain prenatal vt. The pant has had ne agit ‘eedg, ei pan er abromalvagraldschame. Herfrst2 pregnancies ended t 2 weks gestion bre dalenesccured right ‘aga pon flames bya preipzus,nonpsinlvaginaldliey. The pat has ro ceric medal cntions or rer surges. He ery ‘mescaten'sa ptenaawann She des no use ota, acca ok tugs. Vl signs ae normal S622 4g Fela haat ones fae 1odmn.Uasound eves a sre nrautnne fetus measug V4 weeks gst, acral ng cf cm (parma 725), an n0 ‘nora masses. Which eft flowing the est ret step n management fis patent 1A. Aricent) 5 Cetdape placer 25) eta onscto etng () . Poesy acer (5) Rowan prenatal cae ony (4). mits rf ores: convex onc owe LW ree corey Tr Set EB oesoer el iol oe Ceri inuticoney + Calapan cs * Ussinecbnomltes + cane canton + Obst inny 2 or pines, 2d nese ose unica tesures ‘arapenent_[- carianepcanent “This part has cari insuciney, a stucral weakess the cevthatpradepose to seconeiastor pregnancy ss kis dagnosedby any ofthe feng citer + Panless cervical lon ne erent pregnancy (i, examination based) OR + Asecond mest cerucl lena 25cm pus pr Breen dere, uitascund based) OR + 22 prior conseoutv, pales, second rmester losses (esr based), whic wrcay esr ith mid symptom en, vial enue tt spat) alone by precptus ceiver) ‘Because cf ha hich rtf recuroncepatrts wih iston-based evi insufeleny vet wth prophylactic rele, 2 rosie inch a ctr iplaced to rénfrce ard add tere reg the conv. Propylactc ceraze is pone ne fsttinester e, 12-14 teks peta) m potenis wea say of cerval weuTseny Bee can rac n De seordvinester (Chole |. The Sue svemaves at femto alow vagina every (hciee A) Access piel petra or fel aychype asin patent ah suspected fetal ance og, abnormal fst. neste tare stconng tes). is not sed te managenert of carve nsuReny because I seas te eM rand tm romatue apts of membranes. Ca OE)pened “The pabert hae ceric, sacral weakness ite cevathl pedopore lo secontimesie pregnancy les Risagnesedy any ore totewng cera + Piles ceria lion ne erent rearancy (le, xainaonbased) OR + ASecond.neste ceca engin 25cm pia pr prem deve (asain Based) OR + 22 por consecutive, pales, secondarimester losses say tases), whieh Waly sesnt wth Synge, vagus charge, tlt spatng) clone by precptous delivery ‘Secaise the nig se ecurane port ah itery asad erie inauMelaney ucla eh pophylcti cerlage, 2 css eh asus placed to refed ad tre regh tothe cervn Popylcte cerape i peoedn te teatime fe, 12-14 weeks gear) peets wth ase of cerval rsuiseny bore canracur inthe second meter (Chole E}, The sures roves at temto aw vagina ceiver (Chote A) Ancestral kaye anism pant ith suspected fa anes en abooral fiat twnestritgrtedscreenng es) isnot sedi the managarert of cereal neuer becaveitnreasesthe sk of eter aber and preterm grenaterphreofrembranes. (hole ¢) Fetal foronectn (FN), an cxracelar mar proton ects etuean the matoma deiua anda coren is secreted whercver ths itetace issued fe, abn. Therfoe.npatets nth pete conaciers between 22 and 35 weeks gestion FN esng hes singh between pete af lober. Howeve. FN tein isnot sed in pate whore asympora ort -2 wees peta, sich 251s patos, because ofa hgh eo ase peste eats. (hole b) Pessoies ner once recommenced decease lesson onthe ei he ring vers: hatve hey do mat ENE cine scores be, na decease preterm coer fie) anthers aren niger andor management ofcenesinsticecy ‘Education objective: Cervialinstiency, a tucual weakress ofthe con causes piles coil aon, resin in ecoeiester regnanc les. Poerts wn ante af erveal neuen are managed wih preghyact erage peared intel umes to desea te ok faceoy eed esaae tthe ist ecuTeae potris wi history based evil isuiieney a Vesa WEN prophyacte erlage, sce bsnch a srs places rentes ans asters engin tothe cto. Popa crane partes ne fattest, 1214 weeks gestation gates wit a ser of cervalirsuicenybeeetcanrecr inthe second tester (Chole). These removes at (6noiee A) Ancona pica permed for fal Kayo anti npsterts wth suspected fetal aren en, abnormal fst ‘neste iterated scecning test). is not wedi the maragenert of cereal reuferey becaueithrereaesthe sk of preterm abr and preerm renatue rye of manbranes (notes ¢) Fetal oronectn (EN), an enracear max rote ects between he mata deci and tal coton is ecto where this intertaceis sured fe, bo). Therefore in pate wih pretem conaciens between 2 and 36 weeks gestion esing hes asunqusn between pet anataselabe However, FN stg nc Sed ates whoareasympnai fl <2 wees etn, Such ‘5s pat, because ofa hgh eo ase poste esas ee ere cose oucones ie, cease peter coer fs) annette ae loge seo Managemen ef ceca suing) Eévetions objective: Cerveansurisancy, a stucul weakness othe con, cases panes cancal alan, euleg in sesame regan ss. Patents wn ante of cereal ute ere managed wih a eregact erage peared tel mest deen he ek at acuteace References wea nulency dagose, etdopes, ard sk as + ACOG pracice btn o,12: cece for he marapement of cena nse COsterics 8 Greeny Pesan. Chicoinh &Puepertm Incompetent cerEa La COE) 2 Pan eee re ‘A 1yea-sldwoman comes tothe ofce wih a Simon histo of amenorea. Menace eccuted gett ander menstual eyes wore regu urel9 mosh az. The patertras no changes son errcent weightless. Shehasre medical preblamsoprevous genes. Sho eas ahih-ptinlow at ie ands a colegiate soc sloyer. The pets sexulyactvear has rhs of sem wares Intecins. She doesnot use base, acca ei tugs lod presses 12070 nn Hy and pulbe 5 7&mn Gul 620 Kym! On pode xamiaton ewes smal ele and ontender The adpxae arent gabe A premary tests negawe. Pra and TH lees ‘sreromal No mensinalBoedngcccured ato 10-5 ehatenge we mesroxyprogesteore acti, Compared the one poplten ths patents at areatst rk for wich of he flonna?eer el eel ‘A 1yea-sldwoman comes tothe ofce wih a Simon histo of amenorea. Menace eccuted gett ander menstual eyes wore regu urel9 mosh az. The patertras no changes son errcent weightless. Shehasre medical preblamsoprevous genes. Sho eas ahih-ptinlow at ie ands a colegiate soc sloyer. The pets sexulyactvear has rhs of sem wares Intecins. She doesnot use base, acca ei tugs lod presses 12070 nn Hy and pulbe 5 7&mn Gul 620 Kym! On pode xamiaton ewes smal ele and ontender The adpxae arent gabe A premary tests negawe. Pra and TH lees ‘sreromal No mensinalBoedngcccured ato 10-5 ehatenge we mesroxyprogesteore acti, Compared the one poplten ths patents at areatst rk for wich of he flonn? VA. ese bane mineral ens (72%) 2B. Exo rananey (1) (©. Endoatal pepsi (17) . Entree ovata cancr(4%) Vasco sets et fuses) one “oo oa a — Pathophysiology of functional hypothalamic amenorrheaa se Gg Pathophysiology of functional hypothalamic amenorrhea Exess psc anna Vor ew enon tstanaton ‘Wentoss chante ‘See5s & deprossion ‘ora new 1 hat, NPY, GRH, GABA & bata ondorpins ‘epan 1 aaa oy =. F ‘Arena, low estrogonic stl, bono loss (Gt erating tre: ‘Gait gs dos an, NPY = nauopgie¥ ‘ouwonsere a areal ‘an are patent wn secondary anerenea anegave Wegrany ls ard nema prac and TSHevels has 2 cncal pee consent whe capresso fneionalhypthaamie amenonhea. A ges calenae lst 9, mesonyeregestrne acl) canbe performed Cerf ow estrogen levels, he presence of esvogan causes rleaion fhe edorerum, wih sibsoquert sougting ater he wiheravath ‘rogecerne. Patents thot aon esronen il hve ro omnia eding a here sno endorer ing tshed ters win frctnahyptalanicamenares wil deonsate sins and ymptomsofhypestoganem eno, east arophy). They ‘50 have decreased bone mineral densty espe ahysca ang de tohe ow esooen eves ofseting Me bone-in ects of ‘rece. Esogen regu he tres of bone by ostccas ints absence created bnereaionocars. Athewahesto3=n ‘epson cn oe! us, neresing elon irehe andi deceasng exccseis amare cine meats of naeasng bone erty (Chote B) ‘ales progestin challenge lest can cate invautnieathesors eg Aserran seroma patent with 2 so of ering Sneturertaon (og loon nd sretnge) a ener, pie of whcnhasconareda ths patert Patents wth aca ef bal ge) oF pexiceanmaioy dsease ae alnreased isk af edapc Pregarc. A part win avin aesons a teased oferty or ‘ecurert aber. (reiee ) Ensomevia ypepasiaisanskto nase win wnogpssesesvogn stimulation am arawdayaeases suchas pee Oty ‘sya (PCOS), Patents wn PCOS whose wiherawal oedg te apogestene cater es! eo figh eves estogen cag ‘endometial prolfecton (rote D) 5a ptt ovarian carr fepeatdousaton Yau the ovaran sutace wi ech owatny cyl can esta ‘maignnt vanstamaten. This pen has a decease kof ovatan cancer ae one aowuaton ee ee ee ‘wea. Inpaenis n anenarea and vasomot syle, her etclgy (e9 poaty earn Wsuflclecy shou be neste, ‘Eduction objective: Funatocl pana ameneea vets suppression fe hypetalame pty varan aes by sensu exscse cals eseon er ‘rene ness. Patents are aisha deceased bone mn nat eo extopen defena 1350 ave decreed bone mineral nat espe paca ating de foe owes agen lees oseing We bone-budg fects o ‘cvcoe. Esrogenreutes a treskown of bone by otc absence, nreaes bone resoten acu. Atheugh erogon, repeton cn oft tone ss, neeasng calor intake anc deceasng exeoselsa mae ec Mears of nceasng tore erty (oie B) ale ropes change et candle tate adhesions (eg, teen sycome) ina patent with a iy of ing Insturertaton (eg. laon and curetae) or endear, rie of whcnhaseccared nis ater. Patents wth aso ef bal suey pevicifianmaioy disease are atinreaod isk of ecopc prerancy. A ptert wit ingautsne adhesions atinreased isk of iret or (Chole ¢) Encortial perlasiais arf these wth unozposedesrogn simulation fam anova diseases sich 35 poe OY ‘some (PCOS), Patents wih PCOS wilhave wihraval eeing afte progesterone calerge est eo hgh eels of estogen causing nacre rotten (Ghote D) sic for esthelalovarin carers repeated owtaton raurats th ovarian surface wih each own cycle can etn ‘sight raslornaten. The paentha a decenred rato orran cancer de toher ston | (hots) atin wit cial yptalaic amenorhes hae deceased estogen lvl tn vasometr symone, ht ashes, okt neat) Ingen with amenores and vasomaier spies, archer ela ea shia arian insfcieny) shoul be vsti. Eduestiona objective: Funcional ypaalarc arene is veto supresson fhe ypoalamic outa ovarian aes seeruus exec ci Fescon or ronc hess. Pers area isk or deceased bane mine ens ue to estegen defieney Reternene COsterics Gmeeony _FeraleRepecttte System & Breast Amenorhea Ay Co & =)segs 4 =e — EO) se Gg ea ‘A2T yal lira woman comes tothe ofc wi er husband due oat to coreve. The ptt and herhusbnd stooped using ce ‘bari xrtacepton year ape and have recourse every oer day Theat has a pered eer 28 day te as 5 days wth 2 dys of ea hea ow Ske hs ef ec pain aporoxiatel 14 day i ho of stars, utiniecure sree. Inert tens he patent to wa hespatzes ora pele lc, dung a ie se haa pan wih Wetcuse, Same an eer She hao abe Naa SUB fa story. Her sist as peste ovarian syecme. The pats stan 9@ 31 ne has no chien, ands sren amass naa. The 3 tents bod press 6128/78 mm ag pubes 82min. Pryscalexematon sows no gtremattes. Which of te folowrg isthe bat rE) nex sp inmaragement ois pater? L3 OO sysecsipngoacan on B. Laparoscopy = ©. MiscyeeLHieet oa OD. Sewn este! ws OE Sountesostene ee =)eer el eid ‘A2T yal lira woman comes tothe ofc wi er husband due oat to coreve. The ptt and herhusbnd stooped using ‘bari xrtacepton year ape and have recourse every oer day Theat has a pered eer 28 day te as 5 days wth 2 dys of hea ow Ske hs ef ec pain aporoxiatel 14 day i ho of stars, utiniecure sree. Inert tens he patent wa hespatzes ora pele lc, dung a ie se haa pan wih Wetcuse, Same an eer She hao abe Naa SUB story. Her sist as peste ovarian syecme. The pats stan 9@ 31 ne has no chien, ands sren amass naa. The tents bod press 6128/78 mm ag pubes 82min. Pryscalexematon sows no gtremattes. Which of te folowrg isthe bat nex sp inmaragement ois pater? YA ryseresapngogtan 72%) 8. Laparoscopy (9%) ©. Misyele Lioo () D. Sem #54 eel) E Seumtesoserene evel 0%) ‘planation “Tas pant as primary infer, dene 2 lets conceive ae a yea of rpc, ed Sowa rcouse nau pati ge 95. (er ag 35, tery nvestgaton can bepn at S mort). Because the patents ner nas a noma senen anys female actik ent on “Ths patent as pemary inert, defined a aes concave ar aoa of reece, ed sonslinercouse n arulloous part a9e <35. (er ap 35, fey invesigzbon can bepn ater 6 morte). Because the patents anor has anova sen ani, female ator infentiys tre ike eoley This alent hr of hose ving aclescerce sik cet pall inammatery dsesse (PI) 27 orga casera se ol searing and aberuton “The fstine magna st assess alpian ute pteny isa seesaipngnram, wich nels hin ofadeconastins he cv uner fhrrescpy, Hyskreslpngegam trina iasiv anda an teniy cine cry aera (o,carane ven) (hein B) laparoscopy sci fr dec issieton ard vestart of pertneal adhesin ad endometitsis. LEpaescpy wth ‘Srometaton canbe permed asses fo iO-eated scaring rsd thefalepan tutes Power, vase, expense angen (Chole €) Arid.cyce LH eels usd to testforowisten, The LH sug occurs 38 hur porto ution arcane detain rine rt ‘serum. The ptt as requir esta eyes accapari by mice pebic pain tischrerz), whch sugges ewan. Three 29 (Ghote D) Oraran seve tocaly bein decneat ape 3, and swum FSH eves are increased n women uh have a deciing pact cute The patert i conaderaty younger ih reguarmenes, and 202 decrease ov quay ulin ite tecaue of fei, (hoes 8) Increased serum androgen evel can speess onsen by suppressng GnRH ans FSH lease by feedback ihibion.AmoWDh the pets sister has pocorn smeare the patenthas eq cfles anne hypeandogeric spor (eg, sie, rear = ‘Education objective: rear init taueto cones afer 3 yea of reroteced seal rercauseinanulpros pater ape <2. A hysterosaingograis seats agose an anatome cause fletty sun 25 ual esc Hom i pee econmere aa ‘escpy, Haucsalpgegram minimally Waive and als can ety tne caviy aman (0, etre UR) (Ghote 8) laparoscopy is sf fr Sect viseaizaton ard weaerert peroneal acheter ad endometicss. LApacScpy vith CSromubatn an be pedomed ase fo PID ried searing rede thefalepan ter Mower tz nvaae, pene an general (hole €) Arid.cyce Levels used to testfor owen, The LH sue occas 38 tur orto ton ndcan be deteedin rine nd ‘suum. The patent has requ mesa eyiesaccrpania by mice pele pan ntiscunez), heh sugges owen, Tree, an (hoje D) Oraranreseve tcl bein decneat ape 3, and son FSH eves areincreased in women who have a desiring apacty fo ‘ulate Tas pater conscerany younger wih eguar menses, nd soa decrease en quay uly foto ecaseo fet (Ghote 8) Increased seen anstogen levels can speress onto by sippessng GoRHans FSH lease by feedback iibion. Aouoh ‘he petsssterhae pti cnr seme the patent has eg fle anna hypeandrogerc sors (eg hsb, regular mons) Eduction objective: Prmaty anys taweta cone aes a ea of rgosacted sonal neteusein anulprcus pater ape <5, A ystensapingegam eseatoagnose an atone cause fletty sch as ial estucion fom pr pele eect References + Beatmcal cass offre writ and tr management COsterics 8 Greeony Female Repectte System &Sreast_ nityEa La COE) ‘A 2hyacldworan, grads pare, a 35 wees gestation comes ae ereiency depart ue ona, vomtng. ng epgasireand grt upper euaranpan. Sh hasbeen oloved cos fr geen hypertension sce 28 weeks gettin. Her temoeretue i 97.2C (89 FF) bod pressure i 18004 mm Hg ar pulses 20/mn. Phil exarnaten shows @gaeic and right upp quant enceess, Cone ‘curds sight reduced. Fetal hear rat racngshons a basen of 10s win rae vay. ro eeceeraors, ae ccleratons Ther e2¢ edema fine ower erenies Aue pik shows 3+ pan, Lateran recut alos : Cone led cunt Heroin B5ga Pateets scone?Ea La COE) serum chet cretane 1 mga. Lec tuncton ste Teta bain zomg. Drectbinin osmact, ‘Avan pospraase oun Aepatateainctarstenee 3000 Anne annoransrsss 26 UL pase Sut Coanisbon sues ‘Aetvated pri rombopasin, 3g Perera toed smear hows munacusted led cal taper, Which fthe folowing sthe mos ey case of his ater cain? OA. Aawte merovescdafaty initaton of hepatcyesCapuano sues Acated patil rrombopasin, Perera toc smear tous nunacus eed eel Tagen em $02 Which the alongs the mos aly case of his ater contin? (OA awe merovesedar tty taton ot nepatcyes © © Army messed pale estucion 0: mmpares oe aes tow OE Pramatze aceni eparation © Symamicnfaneatin ana ptt consngin|se Gg a Capuano sues ‘Acwated patil rombopasin 25e00 Perera toc smear tous nunacus eed eel Tagen em $02 Which fhe faowing the mos aly case of his pater contin? ‘Aes mervesedar at iuaton of hepa. (12%) 1. Acuewat efeton (1) ©. Araneay mented le cesrcton (10%) 1. paves bie aa tow 6) e Prematse acetal separation (2) YF Systeme naman ane patel consti (88) gies a one ovaranan am noua UW rote coeco, eraed ELL? syndrome (eras cea ver nye, lw pet cunt) ia le trestanngpregrany conplcaen ht maybe a severe ype ct prectampaia. Ths panes severe ypanension and pctenura are conse wih preamp bu elaborating af caren (wi HELP andor HELLPsydiome aught oes tom stool acetaton wgpeing systemic nfaneatn and acon fhe cosqton syste ant cnplement cascade cua platelets ae rapidly consumed, and miroangionathic heey anemia (MAHA) fart) detect tothe liver The esuting hepateellr neeosi ardthomts the pota syst cause oleate ner erzynes, er swag, and detenien| ofthe hepa (Glson capsule. MAHA cavsesinceasedbiiubn poducin (idecthyperbutinera) nd fed tced cel Faprant nb (hole A) Act fay er of pregnancy cn caus aus hepatic fare noth ester rey petparum prod. Mest patents wi have 2 prlenge petro me ad para tworbclstn te, hyogycema, and eceprapaty. However, ers, Fon an eonbocyepen are mre suggestive of HELLP ayer (hoes B) il infect (en, epats) can cause nausea vortng abdorina pan, masa, nd oleate hepsi con enzymes 2 wel 3 fever he ite of which his pent ié not have {hole ¢) Immune tronboctpenc purpura charactrees by arcane pla esructon. Patents ay have cectyresisptecie ‘ancucsa besing, buthe pepo smear may show dereasedruéer fae that are arab zed but atheros (rete ) nranepatecrtstas of pregnancy manfest as geetalzed urs, hpebinonena and Yansamnts aie denston ct ‘sermbile ce conenanen fom mpatedtil ad fow Itdoesnct cause MAHA or Rronbocyopenia (note ) Precclanpia ark toro abrupt laces wich clay resents vagal beara excrucatog adore = a, and line fndemessigity. The dagrei isnt in is patent wo ha lori ndings consi wih HELLPsycme ant = focalpan he wpe absomen, 2 Education cbective: ELLP sjnsome i complenon t prsasanpais hat mone nrombsctopen mereangepshic hao enema anincesea uae .s 17> = ba el Lunes eles star HELLP syetome stu toresat for aeneral pacetabo, agen systemic Fane afd acetone caDUOT IST CamplementcarendeCiising plete ae rapiclyconeumed, and miroangipathic hemi anea (MARA acl deere tomeiner Teresutng hepateallar necrosis ad vont 1 he pota ssl case eve vr eraynes, wer Sualing, ad denn fe hepa (Glsor capsue. MAHA causes inceased bli producn (dec yperbrutinera and fed ced cel tapment n boot (rete A) Act tay Werf pregnancy can cause ace reptile ne ud hmestr ety pestparum pao. est parts wl have {2 prolenged pttremba tne an pra throrbeltn tne, hypogean ecepraopty. Hovever heelys, poten ans thronbocyepenia ae mre supesive of HELLP eye (rete By wal ecto (2, epats) can caise nausea vomtng abdorina pa, malaise, afl eat hepsnchncion eyes as we a fever he ator of which is patent i not have (rete C) mune nronboctopnt purpura ctaateaes by aucemune pace esrucion. Parts may hae eechyrasspsechae and mucosa beeing, bute pearl rear may sow decreased ruber fps thal re arab sized but athens. (reiee D) inranepatecrtstaso prgrancy nanfet 25 geetlzed pus, ypebinuoren, an Vasamnts aie edevaton ct ‘Serumbile a coneruanon tom pated cd Now doesnot cause MAPA a Bronbocyapena reece i aan ie encemessiiy Te clagnos sly nh alent wie has toa ings conssan wah HELLPsypcme ana focal pan ne per abner Educators objective: ELLPsjoatome 2 compleao of prescampsiathatimanes trenbacgapena, mescangepschenaVic arama, abd nessa et cerzymes. The patopenes inaheshpate and sjtemcntanmaton aca ofthe ccagaton cascade and lat consumoton. «+ Pangeress oe syne ofhenhss, leva wer erzynes adopt cout (HELL 2 ee5 Om a tan 202 whiner ang Ne mos ppcpate net sep management ns alent? OA Aamniser usoseonctoic 2 ‘riocerteis luna matty Siphal pole Plsmaresis F Tassels Gg eo CO fe]eer rr el ei a tan 202 hina ange mos ppcpate net sep managements alent? A. Admins usodeancto 25d (1) B. Arwioeress fr lng mturty (26) ©. Bestyscal rote 5) “ B-Boy te 08) a emeyess) “ ree 2) i 5 2 oe ea HELLP syndrome + Prosclampsia + Nausoarvonitinga a CLs) HELLP syndrome + Presclampsia 1 Nauseanomiting + Right upper quatrant somal pain + Micranglopatne Remote anemia Laboratory | Elevated ver enzymes 2 Findings | Low pate count “ + Dalvery s Treatment | Magnesium for seizure prophyanis te 1 Anthypertensive cugs HELLP syndrome (nas cate er eyes, att coun Metrastanng ant assouted wen ouneius complicates (63 edanpsia cet epic dese syndrome, serine eascul coagulation prenturty),Teament of HELLP sydome bags with ‘saizabon ofthe pabert, wich Npcly nce th aisvaton of arohypernsve mescain andlor magnesia fr eau ropyads ‘Aer mtral satizan, delivery Is the ony Gfiniveetment ele shel occur rome at 284 weeks gestation oa ay gesasna oe vith abnoemal felting cr severe worsening mater ‘staus, Tis patent has levtdhepstc ene as et 35 anorectal heat ate acing, Borsseheinoss i sever ard afcing mule rans, heres shouldbe delved expeceréy (Chole A) Lisaasonenat acts testo vet nranepat cscs of pegnany and hao ein the raiment ot HELLPeynctome (ree B) tncenas to ceterine tal ang matty used when wil ad deer planang. Fert patent teks eIHELLFeae HELL? syndrome (nas, eae ver eyes, att coun Metrentenng ant assed woh aunerous conglcatons (23 edenpsia cet repay dvess syndrome, serine inraescu coagulation, rama). Teament of ELLP syndrome cagnsrth _Szizabon ofthe part. whch pcaly ince the aston of arhyperesve mescaon andor magnesia fo sure ropa ‘erm saison, dalivary i he ony defiiivetrestnant Detey shu occur root at 284 weeks gestation ra ay gostanaal ge wih bnomal fetal testing c Severe or worsening mata sous Tis pen has elevated hepaec enames as wel 25a nereacive ea heat rate acing, Because theless sever ad afecing ‘ile eran herfetur oud deleted exper (Gnoiee A) Ursateonchok acd used to reatnaherac cesta of pregnancy and has no roein the veatnert of HELLPenchome (rete 8) Ancertaas to ceterine tal ag mtu used when wild dele planang. Ferths patent te asks eIHELLF ‘yore a greater than those ef delaying devery prog many (rete ) A ephyscal pote nated clay ea tus aera noneacve nonstess esti stale patent wit eat HELL ‘syome and may unnecessaly delay vey (Choiee &)Ptasrapraess removes panagene auantbades n pants eh Yronbotehomaocyopencpupura bust wate 8 treatment ot HELLPeyaome (hciee F) HELLP sco coapltondtrbances ae cone speianessly ater devery Prophylack tasision can be coneed {or ples <20 COM? Fo eesatean det, lopaaive pak vantison ca be carsdeed ef uals COD ma? ‘educations objective: wn detering maternal ta sas . References Tne HELLP aya: il ues and anagem Aree + Efcary ofusadeonctli od inteaing eabepatc chesass of epraney Amciparay ss