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_ Common cases #Pedo__shift

#Plans of Manegment : #Pedo__shift

=D/D of vaginal discharge:( Infections) 1_ Bacterial vaginosis : *C/O : _white to grey discharge + feshy oder *Tret: _ Clindamycin + Metronidazole 2_ Cervictitis ( gonorrhea/ chlamydia): *C/O: _ Mucopurulent vaginal discharge _ Intermenstrual bleeding *Tret: Azithromycin + Cefrixone 3_ Vulvovaginal candiasis: *C/O: _ Itching _white , yeast like smell vaginal discharge _ Dysuria        _ painfull sexual intercourse *Tret: Flucanzole tabs or clotrimazole tabs +Clotrimazole ointment 4_ Trichomonus vaginalis : *C/O :. _ Itching _Yellow to greenish vaginal discharge _Dysuria *Tret: Metronidazole #Obs__shift

Candidiasis

_ Genital warts: * Treatment: - Topical podophyllin -surgical excision - Cryotherapy " using liquid nitrogen "

- Granuloma inguniale: * Caused by klebsiella granulomatosis * present with painless nodules " histo= Donovan bodies " *treatment : Erythromycin

_ Genital TB : *usually following pulmonary TB *present : - Genital ulcer - Amenorrhoea "affects endometrium " - Infertility " affects the tubes " - Acute or chronic pelvic pain - Frozen pelvis " due to sever adhesions"

-Chancroid : *Bacterial infection present with paiful ulcer with drainage of pus * respond to Azithromycin

-primary syphilis "present with painless , single , ulcer with well marked borders on Vulva , vagina or cervix + enlarge inguinal Lymph nodes " - Secondary syphilis " present with maculopapular rash " - Tertiary syphilis " disseminated infection ex neurosyphilis , cardiosyphilis " - penicillin is the drug of choice

_Genital herpes : *Caused by "Hepes simplex virus 2" *present with painful vesicles + multiple ulceration on Vulva + dysuria * treatment: analgesia and local anaesthetic gel + oral acyclovir "if sever"

=D/D of vulval ulcer: _ Syphilis _ Chancroid ulcer _ Tubercloid ulcer _ Lichen planus _Herpes ulcer _ Bahget disease _ Crohn's disease #Obs__shift

Lichen sclerosis

=D/D of vulval itching: 1_Lichen sclerosis 2_Vulval dermatitis 3_ Pruritic vaginal discharge 4_ Atrophic vaginitis 5_worms "entrobious vermicularis" 6_ Systemic causes  "DM , liver failure,  uremia , psoriasis " #Obs__shift

= DVT : =Symptoms: _ Unilateral lower limb swelling + pain _O/E: The affected Limb is hot , tender and warm = Investigations: _ Baseline "CBC & bleeding profile" _ doppler ultrasound "diagnostic " =Treatment: _ low molecular weight heparin can be used during pregnancy " can't cross placenta " #Obs__shift

= Mastitis: _The pt present complaining of Breast pain /swelling/ warmth/ O/E : the affected breast  is erythematous , hot , tender _Tret: * suction of milk from the affected breast is important/  avoid feeding from it * Paracetamol tabs * Amoclan tabs / BD for 10 days #Obs__shift

  =D/D of puerperal pyrexia: _ Endometritis _ Retained placental products _ Mastitis / Breast abscess _ DVT / PE _ UTI _PID _ Tuboovarian abscess #Obs__shift