Dystunctional uterine bleeding _—— 33 Yr Old Le A, fovale pt named samecra who is 0 factory worker wo K- ddan Beedi factory worker by occupation resident of Mmangalornpeta belonging fo tower middle class with @afkly came te oF? with chief complaint - Prolonged ¢ excessive bleed?ng per vagina during menses since ¢ months Sg eo | Ho present tines: PE wos apparently norma} 6 months back when she developed Prolonged and excessive Meeding lasting about If days The bleeding WAS excessive compartd to her previous cycles , previously used +0 Change 1-2 radsfaany but Wis Hime 4-5 Fads [day « PL roUed Fastage of cots For 15+ p days: ~ NO Ho patn ~ MO Hi missed Pertods ~No HIp white dfscharge Pv spatn , Reva ov pain dosing tottus. NO Hy Use CF 3UCD oY ocr: ~ Mo history sugqesHve of rg. = history fuggestive of any bleeding ditorders. — FE underwent laproscopte tabectomy g years baci. ~ No Blo Fakique , breathiessners = NO Hlo intare oF any drags: Menshual_Hlo: OVE Cmu le) Age at menarche -ttyears Past cycles ~ regular x0 days cycles with ¢ dass Flow » 90 pain Ot passage oF clots Lee- 24/os ls. Scanned with CamScannerObatttn'c history + Mayried Hfe ~tr years Obstebic formula - P4l4 DM child — 1 qs jmale FVD booted & immunised = child=13qrs fermate 1! nt = sand child = Uys female" " " so qth child= toys mate" ‘ ” underwent laparoscoph, tecbectomy Pytars bac NO Hlo aboitions last detivery ~fyears baci. Fai} : ily history = ~ 0 Ho bleeding disorder eran ing TS | e4pouve to 8 | cervical (a NO Ho 16 Leptlepsy [asthma FE ancenwent thypofdecto thyrotd: ~> NO heatment taren for extess bleeding pv: Pevsonat tHloz MY Gyears back for complaint oF enlarged a Tares mixed dike =) NOM coppetite NO Sleep distarbane’s Bowel & Hadder~ nonal General physical examination s OE Ee PE fs about 33 yis atd lacy ymodevaltly luitt & nourishes Conscious { alert & cooptiatie 5 sitting comfortably on bed: Pulse ~ BP- RR - erp dubhing , Uyanoris , edema | ° id pallor te , dubbing, Uyanorit edema, S with tigns of mfid pallor, rot tupbaderopay Scanned with /CamScanner~> Thyyoid =~ Seay Over ahepioid YeGfon picsent , not palpable: speasts, spine - Systemic erandinatib ~ CUS S52. heard» NO Muy ~YRSS tyuBS heavd 5 no baserl crepes >cnss NAD fer abdomen examination Tnspeetion = ~ shaped of abdomen -W) umbilicus ~ 0) ~sconesponding quadrant move tqualley with wep: wo virible wass , dilattd veins jsrays ov stnuses: saateh mores present ~dno visible pulsations or peristalsis ~>remnial owiFiees -@ Palpations Sno local rhe CF Herp , no Hendeméss ~> No bsgonornegaly NO palpable mass Percussions rae ~STympante note clewhere 2 b evidente of Fiee uk ?n Abdomen. US LLAALION: 7 ~fowel wounds head « pbs = Bas ol Gly pith dvs Scanned with CamScannerFIBROLD A soyrold ferale pt named Mangala who tsa house wife wo chandia lak fm a fortory by occupation vestient oF Dosavaballi belonging to own roveklle class come 10 OPD with thiey Coroplaines ~ excesstve bleecling per vagina - 4 monthe ~ mass per abdomen — lmonth- Ho PYCLENHNG cormplaintss > TE wns apparently norreal 4 months facie when she clevelnped incensed Heediing during rnenshuation lasting for In Ir days during 30 day OHNE, she changes S-C fads Jday as ogatnst 1-2 fads day eartiey. Flows fs assoufattd with passage of Unb Faber olio voraplains oF assouiattel & pain th the Lower abtorren , starts usith onset oF mensbuation ¢ tq on subiequent days. Pato $s dat aching and in nalue , plesent continuously and often ast & exaMpe: no radfotion , relieved on tating meditation PE nekited wees io her Lowry abdorren in enfd region , tnsidkfous tA onset, ron- FrOgtEsSTVE , not asouated wt th pain 7 Ho Ho uskite discharge PY Fever ~ Mo Ho fatique WEAENESS ; breathlessnec Ho uly Ted Requency of mittusition , incontinence. NO Ho dysporenuiia >0 HO breast discomfort: No Hilo evng atte of Hemp ,tough with tepectorattinn > HO Hlo ony Bleeding ditorders- >No Hlo LUC Mmplortation- ~ NO H[O rTOSS prohuding Out of vagina. Mengioal history: Age at rnenaiche~ Past cycles - Presenl uyeles - LMp— [hemoptysis Scanned with CamScannerObS history Moritd Hie - 15 ays OS index. Ply NO USE OF any conhareptions. NO Ho abortions: family history : Not etgniftcant Past history: NO HHloT® [eptlepsy | nétbrna NO Ho previous surgeries 5 Blood hantfusions Paronal hteroy: Toes mixed diet => appetite ~ normed ~ Sleep sound ~ Bowel § bladder ~ regular s3 Habits - nil: General physical ¢ systemic txam*nations =Somet at above cate: Percibdominal examination: ee ae tNspecti ~> shape oF Abdomen ~nornat umbilicus —nocmat ~ comesponding quadrants moves qualtuy vatth seg Phation: >No dilaltd vetns seas or stnusts: > Shiae albicans “NO visible pulsations “Hania ovffrtes -@ Rolseutfon: NO HNdaness Over , NO Loca vise oF Kemp > Single globular mass RUE tn. hypogathic region , tontesponding to 16 vors 4e steed qiavid uterus , 4x6 em extending. 4cm Above fubte fymphysts. ‘Scanned with CamScannerLOWE fovder NOL made out sup & fal borders are weit defined ayppeans to be astitng bom pelvis ~ Surface- smoot » firm in Consistency => mobile houteontattey hut veitical mobility % teshititd > NO organomegaly on Ocking her fo wale the legs, mass becomes lese prominent Peacussiony “DUI note over the mass: ~> Tympante. note else where ~ Mo evidence of fiee fluid tn the albdomn Austultation, eae Bowel sounds ~ heard Ofagnoris.”_ TAts is a case of fibyid eter conesponding. to 16 wrs gravid ules Scanned with CamScanner€ PROLAPSE A 65 qs old fernale pl named shfvamma who i$ a eoolie clo Rajanna Coolie by occupation vesident of avavaholli belongs to tower middle class came to opp with chief Compladnts ~ Mase per vaginn inte smonths- Nlo_presene Tiness PE WO apparently @D Ernonths back when she initially nokited a mews Pedhudtng fom vagina ubile voiding urine , toridiour onser Ynitfalty the wze of a lemon whith pas gradually, psugressed to Alain present ste mass uted to come out on shainng § coughing & recluces on lyfng down: > PE gives Ho Lifting weights > No Ho bockache > Wo wlo any déchage py [Eleding ry >No Hlo Ted Requency , velention ~ NO fifo burning micturition No HJo vleration “NO Ho chonit constfpation: NO Ulo abdominal distention] ras per abdomen: (menskual History: Age at menarche Post cycles~ present Cycles ~ POMAIN menopeUse Mt yar back- obs histoty+ Monied Life ~ 2s qrs obt fowoula ~ Pt Gi - Gn NO Hlo prolonged delivery sAiticulty tr removt placenta ov big hea Sundeoent tubectomney after 24 chitd i aa 200 Hlo wntraceptves usage last delivery ~25 yrs back: Scanned with CamScannerFast histo: — same Family history: = NO lo similar compledats arnong mother on sitter Parone history: ~ Sane GPE* and SYSHONE Haminations same as above cates: PA examination: ‘Tospection: = shape ot abdomen (0) — umbilicus -(N) f - conuesponding quadrants move equally ewith respiration, = No Scavs [einures: ~peral orities (0) falpation: = NO mass felt PA ~ no organo megaly: PerusePoo = NO signs of free Fluid Ausceute.tion’ ~ Bowel sounds heard t would [ite do fS Cramincdion to complete ¢xamination- ps examfnaction: peecnaallbasee Scanned with CamScannerAvqunéa. 10 Tegan A 404s old fernale pt named Santhamea who fs a bouse Ure uwfo Rallongoppa ceolie by etupation resident of Nelarrangala belonging to lower dass with Prt comes with £ months amenonhea tO OPD with ce - Easy fetiquability, Kinte »monibs- Hlo present Tines ¢ Fe presents wofth @ months of amenosihea voith easy fabigquabiitey since 2 MONths . previduely , the pk was able to do her howsthold Ceoik , buk For the past 2 monins , she gel tired even with minimal coor NO Nlo ted bleeding during menses prior to pregnancy, NO Alo exertional dysprea spapitetion APND 5 pedal edema NO Blo |keding fteae Py NO Hlo wleeding re, pasting worms 1 stools NoHo fiver & burning mictwition: > no H]o Lough stung aie of temp Or Contac+ Lolth cae of TB No Hlo diug inate NO Blo YetLovoith diseeslouration of. shin [seleva« Obs Hilo: Meanied life ~ ys son Cannsanguinous obs indee - G3P, ty reli Goby Cub bist gr Ftv by CU bitth ey Oh, qh Caitd don abter = bivth , malt, b ms sity, ® breastfed 2yrs G) - FIND Cried S007 after Bisth \ 10 yu an Fiat, 3 Ry beast fed =) yrs Scanned with CamScannerLYP ~ pa fit [202 EDD - 09] + [2023 NESEDE pegnaney is conceived spontaneously ytontinned by OPT Me home ~ No NO excessive vorniting — NO Ho reoining sicknese ~NO Flo ted Fiqqueney or busning »pictenition ~No Alo Fever with rash ~N0 Hlo yadiation expoture ~ Ms Io bleeding | discharge Pv ~ folie atid paren + Dating scan done ~ TT Fast dove taken ~NO Hlo Plo: be ~~ Quicrening- 5! month: t= 394 dove sth month: —TIFPA sean done = No #fftory Suggestive oF PIH 5 m4 © LFA tablets (eonsumed) ts: TT ~ Fekat movements perce ved NO Ho bleeding / discharge py ~ NO Ato Fever , headache Haraing of vition. conraceptive bistory: >No Blo uring any conto epive methods menstuat ensteuat history Age OE menarche- Past cycles -paesen cashes ~ uM Scanned with CamScannerEe Fanvily Wo" “INO HO Congenital anomalies ov teofanting » DM, ITN: gast lo: “Sho Milo TE, epilepsy yadthrna = NO NIo previous suigents » BT! GPE: us other system fe examination: “ag Se CNS obs_cxaminatin” anspection’ > Abdomen fs Uniformly drsiended , qlobaler (0 fape: Sumbiicus eventtd , hemfal oxifices- (0) ->Flants donot apyear fall =9 she qravidarum & Gnea niga present NO Has over ctbdomer > Abd circumfeente 16 om sSymphyst0 -fundal he -29em (a3 wts)- fardal qvips sort, hood non~ballotable mass s suggestive of breech: Loser grip —Kneb (Ke Shuttures on st side suggestive DF [mb burs -unifowmn resistonte on lerttide " spine pee gtp* smooth shard , ballotable rrase suggestive of head 28 pelt Gifp: Fingers convage , herd not engaged: wes relaxed Ausculkad tons ris heatd im the IRF spin umbitiead Une. Cl¥2mio siequls) PDS soy old Gatien, with 32 wks oF gestation , moderate anemia Peobotbly dus to tron detidenay ynot th bbour with no dinrcat i495 ok failures Scanned with CamScannerfreqnancy induced hypertension AF Ws ole female pt named Naayont who isa house coife wlo chandra babu pviver by occupation reifdent oF Arovahalli belonging to lower lass came to opp with & rnonths OF meno hea, CC- Cyeneralised edema -since to douy s+ PE SG, PON peesents withs qeneralised edema sinie io days y tnsFdOUS in onsce nftfaltyy notited 7 Lower Liens whfch hove groduatly proguested tO involve the Upper limbs and face. Te ts present Hmoughout the dew mot relieved by overnight ese nor by lib elevation fn the morning: NO HO headache , bluriing of vison oy syncepal attacks NO HO reduced vilne output 5 hernaterria. No Hlo chest patn , palpteatfons or breathlesmess on exerHon or history suggestive oF carcliac failure. No Hlo epigasic pain s nausea , vorniting - 3.NO Blo OM ov Hin: NO HO Janice , ascites before 20 coKs oF gutation Present preg nancy: ‘Obs _hfot > Manfed life - > Obs findex- usp - EDD - Previous pregnancy: ~ Fainless spontaneous aboittbn at ¢th PY pe had gone br 4 AVE Vins 2 scans , iaked. fmmunited « ~NO Hlo ecesive vomiting. ~ No Ho Ny during pregnancy. rionth follguang bkecling Scanned with CamScannerMesent preqnaney - : cil TL Concetved spontaneously & confimed by OPT at home ~ Morning Sferness for 2 manths - present: > Anewosed frequency) of micturition ~ present: > No ulo rou} fatiquabiliiy “ONO HID clesehaige ov bleed PV" NO Wo drug fntake ey radiation expowune eho rica > folic acid taken: > Faltng sean done TT 1 dow taken. st > Qulerening or sb month. > No Hilo headoche , bluned visfon oy cudden fntrear > Tr 2"F dose taren > THEA stan done > BANG visils’ tat in we > Retad_ movements. perceivedt NO Ho bleeding o discharge Pv >No Blo pain abdomen: Genevalfsed edema - Present: > Last abortion ~ lyr bau Bast history: NO Ho pm [ith [TB | epilepsy | psthona NO Alo Br'S oF GN previous surgeries Menstsuad history: Age at menarche : Foust eqcles Lop — NO Ho Connateptiver used. Scanned with CamScannerMarital Klo: mmarvied Life - ~ NON- Concangui nous Pouonal History : NO Hlo DM, HEN asthma 4 tewinning in forrily “> NO Hlo PI Mn mother on sister: Ges systemic examinasion: Obste bic _examtnatton: ‘Fnspection: abdomen — distended §& flonks fall. umbilicus = evated smnrdline > stro. qrOVdarum - present UNI nigre~ present NO vierble pulsations ; stnuses, dilated vefnss “> NO scais over abdomen: > Bernial origices - MD: Palpatton « >Sfundal ht * 29 cm > Fundad he - 32 voks abdominal cerceannference - 96 ern: Grtps* Auscuteation z FHS heard atlong let(re spmoumbilical Ihe , wid point RAK 146 fanin syequiar: Diagnosis + 980 yr old Gy Ay corth 32 wks estaton eclarap cephalic presentation sty, hw An labour, with meid pre-eclampsia Co hey pregnanuy: single live fetus with ‘ad mot engaged and not Nn heatment) complicating Scanned with CamScannerPrevious Lower segment carsarean section A 93 yi old Ferncile patient narned Anita cho iso maid two Madhu fainter by ocecepation westdent oF Kengei belonging to Upp lowe class with ¢ months of Grnenowhea for safe Confinement Obs formula = GyPyL) Hho present mness PL comes with Tmonths ameroithea with a Ho previous Ses uans admitted fo sate confinement: FE had been here for regular anc checkup on 91/0112023 and ws asted to get admftted as her EDD a per scan wads 1811 ]2003- 3 TE Complains OF backache since today momtng tm the lowe mid-back DON Jadiating and nok ass z pain abdomen + > Pe gives lo eohtte discharge shee 4 week , now -foul senting WOE ass € fever OV FEChing: : NO Ho leak Py Or bleeding, PVs > wo Hlo hematasta- >No Hlo any change i bladder habits > RAL movements ave Well pertetved obstetste hfstorys patil Obs formula - Cy, P)Ly uP— EDD- Previous pregnancy s Ti st Ts uneventful Neliveled by tscs ob taney, MObably due to chshucled labor or nen - progression > PE uns nti tans ina ly puter 6) oF laboy by adhninistertng inggctfons , ‘ot Since labo pains ucele not culequatt 5 she wos paled fer Scanned with CamScanneremeigercy Isc 1 after infusing 4 unit oF blood: > out come wora live wale fetus 37kg oF fith 5 was trmuntsecl and exclusively breast fed for Iyear- SMOtha had no fever or vad disehaige in the post-of pevied ~eutares wee removed on 7 day but had to stay in the hospital fa Ye days as the baby had Jaurdic last C SecKON > 2 years bace- Present: pregnancy 1: conceived spontaneously ytontimned by UPT LE OF home a > No Ho tnerased vomitings “2 ND Ho morning sickness SND Hlo Badiation exposcie 2 No HJo fever with rash ND Aly dig intace ~ Folfc acid laren Dating sean - eaten 5 11 VE dose ast = Quictening - rnonths Tt dose > TIFFA Stan done. > NO Hho paupitakions , breathlessness +5 MO Hilo headache odlurring Of vision NO Ho palyphogia , poydipsta- NO MLO bleeding [dseharge Pv" at > Fetal rnovernenis: perceived >No Hlo bleeding [dischaige PV NO Ho RVEYy headache, » blurring éF vesion ™ Scanned with CamScannerPast history = NO KIO OM HIN, 78 ,epileply j asthma id WOnsfurions VO Hl. previous aargeries (except c-section) F bloo : Menshuat to: “> Age at menarche ~ (2. qs ~ Past cycles - > LMp “INE H[o any conhaceptive methods: nagitat Hilo: sy mawied lie~ 4 years won-consangutnous: rally Ho Nd Hlo DM, Hin: Petfonat Hlo: GPE: Sysitmmit. tamination: Obs examination: Tnspection: a Ratpatior a Auscutcuion: Same aS Above cases Diagnosis: 23 year Old GPL with Fall term Single. inhauletine pregnancy sith previous [sce with longtudinat (fe with cephalic presentation not in labour: Scanned with CamScanner