ch 14 rtf.rtf - 1.A 22-year-old architecture major comes to...

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1.A 22-year-old architecture major comes to your office, complaining of severe burning with urination, a fever of 101 degrees, and aching all over. She denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past medical history consists of severe acne. She is currently on an oral contraceptive. She has had no pregnancies or surgeries. She reports one new partner within the last month. She does not smoke but does drink occasionally. Her parents are both in good health. On examination you see a young woman appearing slightly ill. Her temperature is 100.3 and her pulse and blood pressure are unremarkable. Her head, ears, eyes, nose, throat, cardiac, pulmonary, and abdominal examinations are unremarkable. Palpation of the inguinal nodes shows lymphadenopathy bilaterally. On visualization of the perineum there are more than 10 shallow ulcers along each side of the vulva. Speculum and bimanual examination are unremarkable for findings, although she is very tender at the introitus. Urine analysis has some white blood cells but no red blood cells or bacteria. Her urine pregnancy test is negative. Which disorder of the vulva is most likely in this case? A) Genital herpes B) Condylomata acuminata C) Syphilitic chancre D) Epidermoid cyst Ans: A Feedback: Genital herpes consists of small, shallow, painful ulcers. Primary infections are often associated with fever, malaise, and regional lymphadenopathy. The outbreak occurs generally between 1 and 3 weeks after exposure. Herpes is contagious and the majority of transmission occurs without the presence of obvious lesions. Transmission during passage through the birth canal can cause serious illness in affected newborns. 2.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 pain with urination. She has had no fever, malaise, or night sweats. Her past medical history consists of depression and hypothyroidism. She has had two spontaneous vaginal deliveries and one cesarean section. She has had no other surgeries. She denies smoking or drug use. She has two to three drinks weekly. Her mother also has hypothyroidism and her father has high blood pressure and hypercholesterolemia. On examination you see a woman who is anxious but appears otherwise healthy. Her blood pressure, pulse, and temperature are unremarkable. On visualization of the perineum you see two 2- to 3-mm, round, yellow nodules on the left labia. On palpation they are nontender and quite firm. What diagnosis best fits this description of her examination? A) Genital herpes B) Condylomata acuminata Page 1
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C) Syphilitic chancre D) Epidermoid cyst Ans: D Feedback: These cysts are small, firm, round cystic nodules in the labia that are nonpainful. These do not represent a sexually transmitted infection, but rather a blocked sebaceous gland.
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