Biomed Reproduction / STI Take Home Exam
What follows are 6 different case studies involving various aspects of reproduction and STI’s.
You must do 3 cases (no more than 3). Boys must do case #1, girls must do case #2, then choose two other cases
from the remaining five.
On this paper is just the case presentation – go to the website to get the questions that go with each case.
Case #1 A 17 year old boy is awakened from his sleep by sudden, sharp scrotal pain. In the ER, the patient says he
feels nauseous. He reports that the pain is mainly on the left side, and on physical examination, there is evidence of
swelling and reddening of the scrotum. He has a negative cremasteric reflex.
1.
What conditions should be included in the differential diagnosis of scrotal pain?
2.
What is the most likely diagnosis?
3.
What are the possible complications for the patient?
4.
This condition is emergent – what is the most appropriate treatment?
Case #2 A 17 year old girl is brought into the ER complaining of a 3 day history of nausea and vomiting and intense
abdominal pain. Her last menstrual period was 6 weeks ago, but she has a history of irregular cycles. She is not
taking oral contraceptives. Her past medical history is significant for an appendectomy at age 13. Physical
examination reveals a palpable mass in the RLQ. Laboratory tests show beta hCG level is 1500mlU/L, and the
serum progesterone level is less than 15ng/ml. Transvaginal ultrasound, however, reveals no uterine pregnancy.
1.
What is the most likely diagnosis?
2.
What signs and symptoms are commonly associated with this condition?
3.
What risk factors make one more likely to develop this condition?
4.
What is the most appropriate treatments for this condition?
Case #3 A 29 year old woman in week 28 of her 3 rd pregnancy is involved in a motor vehicle accident, but does not
immediately seek medical attention. Four hours after the accident, she notes lower abdominal pain and vaginal
bleeding, and decides to go to the ER. Upon presentation, the patient appears quite comfortable and says she’s
experiencing what she believes to be prolonged contractions. Her vital signs are notable for mild hypotension.
Relevant lab findings are as follows:
Hematocrit 34%
Platelet count 80,000/mm3
Plasma fibrinogen: 180mg/dL
1.
What is the differential diagnosis of painful vaginal bleeding in the third trimester?
2.
What is the most likely diagnosis?
3.
What is the physiological explanation of this condition?
4.
What treatment(s) are most appropriate?
Case #4 A 22 year old woman presents to the clinic with complaints of itching, burning on urination; and a green,
fishy-smelling vaginal discharge. She has had four different sexual partners in the past year (not judging though!!!),
and reports she has used protection in each case. A wet smear of the discharge shows epithelial cells with smudged
borders.
1.
What conditions should be considered in the differential diagnosis?
2.
What is the most likely diagnosis?
3.
What risk factors are associated with an increased incidence of this condition?
4.
What is the most appropriate treatment for the condition?
Case #5 A 26 year old woman presents to her physician complaining of intense abdominal pain associated with the
start of her menstrual periods. She has been trying unsuccessfully to get pregnant for the past two years. On
questioning, she reports pain with intercourse (she is married!!!). Her older sister has a similar history.
1.
What is the most likely diagnosis?
2.
What is the physiology associated with the disorder?
3.
What risk factors are associated with an increased incidence of this condition?
4.
What is the most appropriate treatment for the condition?
Case #6 A patient with diabetes presents to her physician with an adherent white flaky substance on the skin under
her breasts. Another patient, a woman who has just completed a course of oral antibiotics, presents with itching and
a copious vaginal discharge that resembles “cottage cheese”. A third patient, with AIDS, presents with a white
exudates on his oral mucosa and soft palate. The physician diagnoses the same causative microorganism for all
three cases.
1.
What is the most likely diagnosis?
2.
Where is the microorganism that causes this condition normally found?
3.
What populations are most at risk for this condition?
4.
What are the most appropriate treatments for this condition?