Office Gynecology: A Case-Based Approach

Description:

This case-based guide covers 100 gynecologic problems commonly encountered in office practice settings, from the simple to the complex. It encourages evidence-based care and incorporates up-to-date guidance on evaluation and management in office practice. Clinical problems are discussed in a clear, case-based format. The book integrates current guidelines and recommendations, supplemented with carefully-researched and vetted expert opinion for situations for which no guidelines exist. Each gynecologic problem is assessed through a brief case presentation followed by an in-depth discussion with visual aids. Question and answer sections feature teaching points. Cases and discussions are detailed enough to guide practice, yet remain focused and concise, with each case designed to be read in the time available when seeing a patient in clinical practice. An invaluable reference guide for gynecologists, family physicians, internal medicine providers, and other women's health care providers who offer office-based gynecologic care.

Table of Contents:

Section 1 Pelvic Pain

Case 1 A 27-Year-Old Woman with Recurrent Visits for Severe Pelvic Pain

Case 2 A 25-Year-Old Woman with Deep Dyspareunia

Case 3 A 16-Year-Old Adolescent with Ongoing Dysmenorrhea Despite Oral Contraceptive Pill Use

Case 4 A 37-Year-Old Woman with Pain at the Lateral Aspect of Her Pfannenstiel Incision

Case 5 A 26-Year-Old Woman with Chronic Pelvic Pain and Negative Work-Up

Case 6 A 30-Year-Old Woman with Endometriosis with Worsening Pelvic Pain Despite Continuous Oral Con

Case 7 A 47-Year-Old Woman with Severe Menstrual Cramps and Painful Intercourse

Section 2 Vaginal Discharge and Sexually Transmitted Infections

Case 8 A 28-Year-Old Woman with Metronidazole Allergy and Trichomonas Infection

Case 9 A 24-Year-Old Woman with Mucopurulent Cervicitis

Case 10 A 27-Year-Old Woman with Trichomonas Requesting a Prescription for Her Partner

Case 11 A 33-Year-Old Woman with Multiple Visits for Vaginal Discharge and Itching

Case 12 A 24-Year-Old Woman with Trichomonas in the First Trimester of Pregnancy

Case 13 A 16-Year-Old Adolescent Requesting Confidential Treatment for Chlamydia Exposure (Understan

Case 14 A 75-Year-Old Woman Complaining of Greenish Discharge

Section 3 Amenorrhea and Abnormal Vaginal Bleeding

Case 15 A 32-Year-Old Woman with Friable Cervix

Case 16 A 28-Year-Old Woman with Secondary Amenorrhea and Family History of Mental Retardation (Frag

Case 17 A 27-Year-Old Female Runner with Secondary Amenorrhea

Case 18 A 38-Year-Old Woman with Secondary Amenorrhea Six Months after Gastric Bypass

Case 19 A 25-Year-Old Woman with a Levonorgestrel Intrauterine Device (LNG-IUD), New Onset Spotting,

Case 20 A 30-Year-Old Woman with Irregular Periods (Hypothyroidism)

Case 21 A 25-Year-Old Woman with Midcycle Spotting

Section 4 Contraception and Abortion

Case 22 A 25-Year-Old Woman with No IUD String Visible One Year after Placement (IUD in Uterus)

Case 23 A 29-Year-Old HIV-Positive Woman Requesting Oral Contraceptive Pills

Case 24 A 42-Year-Old Woman with IUD and Actinomyces on Cervical Cytology

Case 25 A 25-Year-Old Woman with a History of Pulmonary Embolism on OCPs Who Desires Contraception

Case 26 A Pregnant 22-Year-Old Woman Who Desires Long-Acting Postpartum Birth Control (Immediate Pos

Case 27 A 33-Year-Old G4P4 Unable to Palpate Implant Desiring Removal

Case 28 A 24-Year-Old Woman with a Contraceptive Implant Placed Three Weeks Ago Presents with Positi

Case 29 A 32-Year-Old HIV-Positive Woman Requesting IUD

Case 30 A 23-Year-Old Woman Presents Two Hours after Sexual Assault

Case 31 A Woman with a BMI of 40 kg/m2 Requests Oral Contraceptive Pills (Efficacy of Contraceptive

Section 5 Breast Problems

Case 32 A 41-Year-Old Woman with Bilateral Clear Nipple Discharge (Physiologic Discharge)

Case 33 A 38-Year-Old Woman with New-Onset, Unilateral Bloody Nipple Discharge

Case 34 A 34-Year-Old Newly Pregnant Woman with a Breast Mass

Case 35 A 29-Year-Old Woman with Lactational Mastitis and Persistent Fevers and Erythema

Case 36 A 45-Year-Old Woman with Unilateral Green Nipple Discharge (Duct Ectasia)

Case 37 A 35-Year-Old Woman Who Complains of Cyclic Breast Pain (Idiopathic Mastodynia)

Section 6 Cancer Screening and Prevention

Case 38 A 22-Year-Old Woman with LSIL on Initial Cervical Cytology

Case 39 A 25-Year-Old Woman Who Has Received a Letter from an Aunt Recommending Lynch Testing (Casca

Case 40 A 30-Year-Old Woman with Positive Margins on LEEP for HSIL

Case 41 A 32-Year-Old Woman Whose Paternal Aunt and Grandmother Had Ovarian Cancer

Case 42 A 23-Year-Old Woman with HSIL on Cervical Cytology

Case 43 A 35-Year-Old Woman with a Strong Family History of Breast Cancer Not Linked to BRCA Mutatio

Case 44 A 25-Year-Old Woman with LSIL Desiring HPV Vaccination

Section 7 Vulvar Disease

Case 45 A 55-Year-Old Woman with a White, Itchy Lesion on the Vulva (Lichen Sclerosus)

Case 46 A 55-Year-Old Woman with a New Wart (Vulvar High-Grade Squamous Intraepithelial Lesions)

Case 47 A 25-Year-Old Woman with Perineal Pain and Inability to Have Intercourse (Vestibulodynia)

Case 48 A 30-Year-Old Woman with New Vulvar Lesions (Condyloma Accuminata)

Case 49 A 50-Year-Old Woman with Lichen Sclerosus, Fused Labia, and UTIs

Case 50 A 25-Year-Old Woman with Recurrent Candida Vaginitis

Case 51 A 35-Year-Old Woman Complaining of a “Knot” in the Vulva (Bartholin’s Cyst)

Section 8 Infertility

Case 52 A Couple with Medicaid and No Conception after Two Years (Cost-Conscious Infertility Evaluat

Case 53 A 33-Year-Old Woman with Infertility (Bilateral Hydrosalpinx)

Case 54 A 26-Year-Old Woman with Irregular Menses and Infertility

Case 55 A 32-Year-Old Woman with a 3 cm Endometrioma and Infertility

Case 56 A 32-Year-Old Woman with Recurrent Pregnancy Loss

Section 9 Preconception Planning

Case 57 A Couple Planning Pregnancy Who Have Just Returned from Brazil (Zika Virus)

Case 58 A 26-Year-Old Woman with a History of Depression Planning Pregnancy

Case 59 A 25-Year-Old Woman with a History of DVT Presents for Preconception Counseling

Case 60 A 25-Year-Old Ashkenazi Jewish Woman Who Desires Pregnancy

Case 61 A 40-Year-Old Woman with Chronic Hypertension on Atenolol Planning Pregnancy

Case 62 A 30-Year-Old Woman with a History of Diabetes Controlled on Oral Agents Planning Pregnancy:

Section 10 Pediatric and Adolescent Problems

Case 63 A 14-Year-Old Adolescent with a Large Labia

Case 64 A 16-Year-Old Adolescent with Acne, Hirsutism, and Irregular Menses

Case 65 An Eight-Year-Old Girl with Persistent Vulvar Itching

Case 66 A Four-Year-Old Girl with Recurrent Vulvar Discharge and Itching

Case 67 A 15-Year-Old with Painful Vulvar Ulcers

Case 68 A 15-Year-Old Adolescent Who Is Unable to Use a Tampon

Case 69 A Six-Year-Old Girl with Breast Development (Precocious Puberty)

Case 70 A 13-Year-Old Adolescent with Primary Amenorrhea and Cyclic Abdominal Pain (Imperforate Hyme

Case 71 A 17-Year-Old Adolescent with Secondary Amenorrhea

Section 11 Pelvic Masses and Cysts

Case 72 A 53-Year-Old Woman with a 3 cm Dermoid Cyst Noted as an Incidental Finding on CT

Case 73 A 60-Year-Old Woman with a 4 cm Simple Ovarian Cyst

Case 74 A 25-Year-Old Woman with a 2 cm Simple Asymptomatic Cyst Noted Incidentally on Ultrasound

Case 75 A 25-Year-Old Woman with Endometriosis and a 4 cm Endometrioma

Case 76 A 25-Year-Old Woman with Abrupt Onset of Pelvic Pain, Nausea and Vomiting, and Adnexal Masse

Case 77 A 30-Year-Old Woman with Fever, Abdominal Pain, Vaginal Discharge, and Adnexal Mass (Tubo-Ov

Case 78 A 45-Year-Old Woman with Pelvic Pain One Year after TLH/BSO for Endometriosis (Ovarian Remna

Case 79 A 21-Year-Old Woman at Five Weeks EGA with Left Lower Quadrant Pain

Section 12 Incontinence and Prolapse

Case 80 A 30-Year-Old Woman with Postpartum Flatal and Fecal Incontinence

Case 81 A 46-Year-Old Woman with Leakage of Urine

Case 82 A 48-Year-Old Woman with Microscopic Hematuria and Negative Urine Culture

Case 83 A 55-Year-Old Woman with Urinary Urgency and Negative Urinalysis and Culture

Case 84 A 30-Year-Old Woman with Frequency, Urgency, Nocturia, and Pressure Relieved by Urination: (

Case 85 A 25-Year-Old Woman with Recurrent Urinary Tract Infections

Case 86 An 80-Year-Old Woman with Total Procidentia with Vaginal Irritation

Case 87 A 60-Year-Old Woman Presenting with Difficulty with Defecation (Posterior Wall Defect)

Section 13 Behavioral, Sexual, and Social Health

Case 88 A 25-Year-Old Woman with Recurrent STDs (Human Trafficking)

Case 89 A 41-Year-Old Woman with Loss of Interest in Having Sex

Case 90 A 28-Year-Old Transgender Woman Requesting Well-Woman Visit

Case 91 A 35-Year-Old Female-to-Male Transgender Patient with Vaginal Spotting on Testosterone

Case 92 A 23-Year-Old Woman Who Reports Inability to Consummate Her Marriage Due to Vaginal Pain (Va

Case 93 A Tearful 32-Year-Old Woman Requesting a Sleeping Aid Two Weeks after Delivery (Postpartum D

Section 14 Menopause and Aging

Case 94 A 50-Year-Old Breast Cancer Survivor with Severe Hot Flashes

Case 95 A 56-Year-Old Woman with Dyspareunia

Case 96 A 60-Year-Old Woman with FRAX® Score Indicating a 10 Percent Probability of Osteoporotic Fr

Case 97 A 45-Year-Old Woman with Menses Every 60–90 Days and Hot Flashes

Case 98 A 70-Year-Old Victim of Elder Abuse

Index