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  #1  
Old 03-24-2012
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Default O/B question..............pls explain

A 27-year-old woman is brought to the emergency
department by
her mother who found her comatose 30 minutes ago. Her
mother says that
her daughter had been having lower abdominal pain and
vaginal bleeding
over the past week. The patient had an ectopic
pregnancy 2 years ago
and was also treated with doxycycline for pelvic
inflammatory disease at
that time. Her blood pressure is 40/20 mm Hg, pulse
is 160/min, and
respirations are 24/min. The abdomen is distended and
rigid with
decreased bowel sounds. Hemoglobin level is 4.2 g/dL,
and leukocyte count is
12,500/mm3. Culdocentesis is positive. Which of the
following is the
most appropriate next step in management?

A
) Bromocriptine therapy

B
) Clomiphene therapy

C
) Conjugated estrogen therapy

D
) Ergot derivative therapy

E
) Hysteroscopy

F
) Laparoscopy

G
) Dilatation and curettage

H
) Endometrial ablation

I
) Exploratory laparotomy

J
) Total abdominal hysterectomy

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  #2  
Old 03-24-2012
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Quote:
Originally Posted by achistikbenny View Post
A 27-year-old woman is brought to the emergency
department by
her mother who found her comatose 30 minutes ago. Her
mother says that
her daughter had been having lower abdominal pain and
vaginal bleeding
over the past week. The patient had an ectopic
pregnancy 2 years ago
and was also treated with doxycycline for pelvic
inflammatory disease at
that time. Her blood pressure is 40/20 mm Hg, pulse
is 160/min, and
respirations are 24/min. The abdomen is distended and
rigid with
decreased bowel sounds. Hemoglobin level is 4.2 g/dL,
and leukocyte count is
12,500/mm3. Culdocentesis is positive. Which of the
following is the
most appropriate next step in management?

A
) Bromocriptine therapy

B
) Clomiphene therapy

C
) Conjugated estrogen therapy

D
) Ergot derivative therapy

E
) Hysteroscopy

F
) Laparoscopy

G
) Dilatation and curettage

H
) Endometrial ablation

I
) Exploratory laparotomy

J
) Total abdominal hysterectomy

unstable DUB needs IV estrogen so C?
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  #3  
Old 03-24-2012
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i) exploratory laprotomy??
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  #4  
Old 03-24-2012
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Quote:
Originally Posted by umajeed90 View Post
i) exploratory laprotomy??
yes.100% it's I. pt has ruptuer ectopic pregnancy(Culdocentesis:is old procedure used to diagnosed rupture ectopic befor the apperance of u/s.)
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  #5  
Old 03-24-2012
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Ex lap, definitely!
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  #6  
Old 03-24-2012
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already the patient is in hypotensive shock ,,,so performing ex lap causes further bleeding so it may stil dangerous ..i will go laproscopy first...

i think so...
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  #7  
Old 03-25-2012
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for which ever procedure she has to go she will be well resuscitated with normal saline and blood transfusion before any procedure whether its laproscopy or expl laboratomy. but my ans is exploratory laboratomy bcos of the ruptured ectopic pregnancy has caused obvious peritonitis .
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