Answers
1. A 24-year-old travel agent comes to your clinic, complaining of
pain and swelling in her vulvar area. She states that 2 days earlier
she could feel a small tender spot on the left side of her vagina but
now it is larger and extremely tender. Her last period was 1 year
ago and she is sexually active. She uses
the Depo-Provera shot for contraception. She denies any
nausea, vomiting, constipation, diarrhea, pain with urination, or
fever. Her past medical history is
significant for ankle surgery. Her mother is healthy and her father
has type 2 diabetes. On examination she appears her stated age
and is standing up.
She states she cannot sit down without excruciating pain. Her blood
pressure, temperature, and pulse are unremarkable. On visualization
of her perineum, a large, red, tense swelling is seen to the left of
her introitus. Palpation of the mass causes a great deal of pain.
What disorder of the vulva is most likely causing her problems?:
Bartholin's gland infection
2. A 48-year-old high school librarian comes to your clinic,
complaining of 1 week of heavy discharge causing severe itching.
She is not presently sexually active and has had no burning
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, with urination. The symptoms started several days after her last
period. She just finished a course of antibiotics for a sinus
infection. Her past medical history consists of type 2 diabetes
and high
blood pressure. She is widowed and has three children. She
denies tobacco, alcohol, or drug use. Her mother has high blood
pressure and her father died of diabetes complications. On
examination you see a healthy-appearing
woman. Her blood pressure is 130/80 and her pulse is 70. Her head,
eyes, ears, nose, throat, cardiac, lung, and abdominal
examinations are unremarkable.
Palpation of the inguinal lymph nodes is unremarkable. On visualization
of the vulva, a thick, white, curdy discharge is seen at the introitus. On
speculum ex- amination there is a copious amount of this discharge.
The pH of the discharge is 4.1 and the KOH whiff test is negative, with
no unusual smell. Wet prep shows budding hyphae. What vaginitis does
this patient most likely have?: Candida vaginitis
3. Which of the following represents metrorrhagia?: bleeding between
periods
4. A 42-year-old realtor comes to your clinic, complaining of
"growths" in her vulvar area. She is currently undergoing a divorce
and is convinced she has
a sexually transmitted disease. She denies any vaginal discharge or
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