tailieunhanh - Thực hành xử lý sản khoa - Trường hợp 2

Tham khảo tài liệu 'thực hành xử lý sản khoa - trường hợp 2', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 56 A 3 1-year-old woman comes in for a well-woman examination. Her last menstrual period was 2 weeks ago. She has no significant past medical or surgical history. She denies having been treated for sexually transmitted diseases. On examination her BP is 130 70 HR 70 min and temperature is afebrile. Her thyroid is normal on palpation. Her heart and lung examinations are within normal limits. The abdomen is nontender and without masses. Examination of the external genitalia reveals a nontender firm ulcerated lesion approximately 1 cm in diameter with raised borders and an indurated base. Bilateral inguinal lymph nodes arc also noted that arc nontender. Her pregnancy test is negative. What is the most likely diagnosis What is your next step in diagnosis What is the best therapy for this condition 428 CASH EILES OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 56 Syphilitic Chancre Siiniiiitirv A 31-year-old woman who comes in for a well-woman examination is noted to have a nontender firm 1-cm ulcerated lesion of the vulva it has raised borders and an indurated base. She also has bilateral nontender inguinal lymphadenopathy. Most likely diagnosis Syphilis primary chancre . Next step in diagnosis Syphilis serology RPR or VDRL and if negative darkficld microscopy. Best therapy for this condition Intramuscular penicillin. Analysis Objectives 1. Know the classic appearance and presentation of the chancre lesion of primary syphilis. 2. Know that penicillin is the treatment of choice for syphilis. 3. Understand that the antibody tests VDRL or RPR rnay not yet turn positive with early syphilitic disease and that darkfield microscopy would then be the diagnostic test of choice. Considerations This 3 1 -year-old woman came in for a well-woman examination. It was unexpected to find the lesion in the vulva area. The patient denies any history of sexually transmitted diseases. Nevertheless she has the classic lesion of primary syphilis the painless chancre. It is typically a .