nbme1.2.3 - rotors

[ArchivalUser]

u have a good pt wissam but still if a mass disappears in 2 wks .. why go for an expensive inv like ct scan when it is not an emergency condition ..rt.. if at all it persists we can go for ct later !

[ArchivalUser]

@wissam...correcrion first...the most common cause of postmenpausal bleeding is vaginal or endometrial atrophy....


in cases you mentioned those are more serious diseases...with metastasis..need urgent care..i agree...but not the case here..if anything in the question stem pointed to a cancer diagnosis would have gone for ct...she is perfectly normal....

also if a patient comes to you with hemoptysis and fever...no indication of any malignany in history...you dont send him to CT first..you give antibiotics. get chest x ray first, then you consider a malignant diagnosis

[ArchivalUser]

Rotor could you please explain to me what do you mean by ( GOOD PATIENT ) ,did she promise you not going to sue you if ruptured or twisted cyst happened ????

[ArchivalUser]

lol....its "good point" ..wissam not "good patient"...
also dont bring "if " cenario in the situation...

[ArchivalUser]

ckindec did you hear about recurrent pneumonia in asmoker patient it is fever & infection but the real cause is mass ...any way the conversation is long about that ...but the rule confirm the diagnosis before start treatment or follow up .....like patient come with all feature of hypothyroidism we dont start thyroxine right after the exam ????

[ArchivalUser]

@wissam....you are yourself confusing the point....the patient with reccurent pneumonis will have history of "recurrent pneumonias" in his history...thus we will investigate first....not for a patient with first time pneumonia with normal history...

also we are confirming the diagnosis here by re-examining after two weeks.....thus confirming the diagnosis......

[ArchivalUser]

the discussion has become interesting here .... pursuit , foreever n others .. what do u think ?

[ArchivalUser]

I think after exclusion, ans is A.

Want to do USS stat, but not in the option, CT is not cost effective for this healthy girl.

5cm is below the cut off of 7cm for ovarian cyst.

menstrual HO is not significant, although tender ov cyst may be endometriosis,there is no dysmenorrhoea, so exclude laparoscopy.

LMP 3 wks ago, that actually exclude follicular cyst , that is in 2wks after menstration, before ovulation. But, still can be corpus leuteal cyst that is after 3 wks of mens, slight tenderness may be due to tension to the capsule . (usu; not tender)

B & C should be after Imaging.

So, ans should be A.

[ArchivalUser]

i want any one of ou guys tell me where did they read the rule of 5 cm adnexial mass should be followed conservatively and cost effective term .... by the way if simple cyst get larger than 7 cm is indication for laproscopic intervention....

[ArchivalUser]

check on line on obgyn literature and family medicine about taking care of adnexal mass .......in the managemant they say if mass is upto 10 cm/less than this size than observe it for 4-6 wks in premenopausal woman.
so plz google it out even it is in emedicine too