Ouli Maty
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A 17 y -o girl complaints of nausea and abd cramp more severe in the early morning hours. She also complaints of vaginal discharge. She is sexually active since the age of 15 and have 2 weeks delayed in her menstrual cycle. She more likely has one of these conditions:
A-Polycystic ovarian disease
B- Sexually transmitted disease
C-High Estradiol secretion
D-2 weeks pregnancy
E-Pelvic inflammatory disease.
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| mapetrsn
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Actually, I want to say both B and E. But I know that must be wrong. Anyway, my thinking is that she is having an anovulatory cycle due to PID. This is brought about by an active chlamydia or gonorrheal infection, hence the discharge. Where am I wrong?
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| mjl1717
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Ill rule out 2or 3--With Polycystic ovaries you do not think of discharge,but hirsutism due to increase testosterone, increase LH decrease FSH (but her age and the fact that she has amenorrhea matches)
Estradiol is sometimes used to suppress lactation-never heard of that causing pathology.
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| athzaf73
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I think its pregnancy .
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| mapetrsn
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I don't think its pregnancy because she would not be having a vaginal discharge. I confess I'm stumped, I'm just sure that it can't be A,C, or D.
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I still think its pregnancy. the most defining clue to it comes from the delay she has in her cycles. Thats the single most important tip-off.
She probably had sex with someone who got her pregnant as well as gave her an STD but I'm convinced it is pregnancy.
Thats what I would choose.
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In addition having nausea early in the morning further goes in the favor of pregnancy. I would consider the discharge a distractor.
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| athzaf73
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Look!
The girl has delayed menses and early morning sickness, That's pregnancy until proven otherwise.
In addition she has got an STD which is causing the discharge , which she probably got from the same source as the pregnancy or from any other sexual contact over time.
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| Param
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Is it D?
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| mjl1717
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Ill rule out 1 or 2 more-PID is associate with abdominal PAIN and Tenderness, cervical motion tenderness, adnexa tenderness
*** Pregnant women get discharges- Leukorrhea-,increased estrogen,increased cervical mucous. The miky color is due to epithelial desquammation which accompanies hyperplasia and hypertrophy of cervical and vaginal surfaces. Lactobacillus is present in large numbers to maintain a favorable pH.
As athzaf said "pregnancy till proven otherwise"
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| Ouli Maty
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Sorry the Q was not well written.
In D it is 4 instead of 2 weeks.
Other than that everything is correct.
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| athzaf73
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then its 4 week pregnancy!
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| Ouli Maty
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Yes it is D. I guess the error made it difficult for a pick. I am sorry again.
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