third trimester with clear vaginal fluid..dx? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 05-12-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
ObGyn third trimester with clear vaginal fluid..dx?

A 20-year-old, G 1 PO, woman at 35 weeks gestation comes to the hospital because of regular uterine
contractions and passage of clear fluid per vagina. She has no other symptoms. Her pregnancy thus far has
been uncomplicated Her temperature is 38.2 C ( 1 DO. 7 F), blood pressure is 120/68 mmHg, pulse is 11 0/min
and respirations are 17/min. Speculum examination shows a closed cervix and clear fluid pooling in the
vaginal fornix. The pH of the fluid is 7.5. F eta I heart monitoring shows a rate of 165/min and uterine
contractions occurring every 3-4 minutes. Initial laboratory studies show:
Hemoglobin 10.2 g/L
Platelets 198 ,OOO/mm3
Leukocyte count 18 ,500/mm3
Neutrophils 86%
Lymphocytes 14%

Which of the following is the most likely diagnosis?
A. Abruptio placenta
B. lntraamniotic infection
C. Urinary tract infection
D. Trichomonas vaginitis
E. Normal labor
Reply With Quote Quick reply to this message



  #2  
Old 05-12-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 246
Threads: 18
Thanked 142 Times in 86 Posts
Reputation: 152
Default

B the pt most like developed chorioamionitis
Reply With Quote Quick reply to this message
  #3  
Old 05-13-2012
USMLE Forums Scout
 
Steps History: Not yet
Posts: 17
Threads: 5
Thanked 4 Times in 4 Posts
Reputation: 14
Default

the lady has a premature rupture of membranes probably caused by the intraamnoitic infection(the most common causeof PROM)....
Reply With Quote Quick reply to this message
 
  #4  
Old 05-13-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 762 Times in 256 Posts
Reputation: 773
Default answer is B

its definitely PROM + labor
because it satisfies most of the criteria
1- regular contractions >3contractions/30minutes
2- pooling of vaginal fluid
3- the Cx is dilated ---- ??

due to increased WBC/Neutrophils and increased temperature
it shud be B

if they asked management.
it wud be to continue with the labour n deliver the baby.

what is the treatment though?
Reply With Quote Quick reply to this message
  #5  
Old 05-13-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 246
Threads: 18
Thanked 142 Times in 86 Posts
Reputation: 152
Default

in chorio utrine contraction may occur without real labor
in this case this isn't a labor, cuz as u said NOT associated with cervical dilation
the next step here is Abx then the mgm will be according to the baby's age and lung function
deliver if the baby is in danger, (if we notice baby's HR is 160 which upper nl limit) i think we need to do NST to see if the baby is jeopardized or no, if yes delivery is mandatory
Reply With Quote Quick reply to this message
  #6  
Old 05-13-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 762 Times in 256 Posts
Reputation: 773
Default

Quote:
Originally Posted by bisho View Post
in chorio utrine contraction may occur without real labor
in this case this isn't a labor, cuz as u said NOT associated with cervical dilation
the next step here is Abx then the mgm will be according to the baby's age and lung function
deliver if the baby is in danger, (if we notice baby's HR is 160 which upper nl limit) i think we need to do NST to see if the baby is jeopardized or no, if yes delivery is mandatory
ok i just opened up my notes n read.
kaplan notes clearly say----

IF THERE IS PROM WITH CHORIOAMNIONITIS
(diagnosis----->fever+PROM+ absence of URI/UTI)
THEN DELIVER ASAP under cover of GENTAMICIN+CLINDAMYCIN.


dont wait for stress test/maturity/lung function/fetal jeopardy etc
CHORIOAMNIONITIS is a CONTRAINDICATION to let pregnancy continue.
Reply With Quote Quick reply to this message
The above post was thanked by:
bisho (05-13-2012), halabian (05-13-2012)
  #7  
Old 05-13-2012
USMLE Forums Scout
 
Steps History: Not yet
Posts: 17
Threads: 5
Thanked 4 Times in 4 Posts
Reputation: 14
Default

Quote:
Originally Posted by mbbs2010 View Post
ok i just opened up my notes n read.
kaplan notes clearly say----

IF THERE IS PROM WITH CHORIOAMNIONITIS
(diagnosis----->fever+PROM+ absence of URI/UTI)
THEN DELIVER ASAP under cover of GENTAMICIN+CLINDAMYCIN.


dont wait for stress test/maturity/lung function/fetal jeopardy etc
CHORIOAMNIONITIS is a CONTRAINDICATION to let pregnancy continue.
thanks.so do we use cesarean delivery here because the cervix is closed?
Reply With Quote Quick reply to this message
  #8  
Old 05-13-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 246
Threads: 18
Thanked 142 Times in 86 Posts
Reputation: 152
Default

no this is not an indication for c-section
just induce the labor with oxy
Reply With Quote Quick reply to this message
  #9  
Old 05-13-2012
USMLE Forums Scout
 
Steps History: Not yet
Posts: 17
Threads: 5
Thanked 4 Times in 4 Posts
Reputation: 14
Default

Quote:
Originally Posted by bisho View Post
no this is not an indication for c-section
just induce the labor with oxy
but the cervix is closed?
Reply With Quote Quick reply to this message
  #10  
Old 05-13-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

Dx is prom.
Prom does not mean Preterm labor. Cervix can be closed in prom. The triad mentioned above is for ptl and not for prom.
This is what I got from Kaplan Obs.

I guess she need nvd ... Chorioamnionitis is not indication for c section. Hope m correct


Sent from my iPhone using Tapatalk
Reply With Quote Quick reply to this message
  #11  
Old 05-14-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 137
Threads: 2
Thanked 65 Times in 40 Posts
Reputation: 75
Default

Quote:
Originally Posted by tyagee View Post
Dx is prom.
Prom does not mean Preterm labor. Cervix can be closed in prom. The triad mentioned above is for ptl and not for prom.
This is what I got from Kaplan Obs.

I guess she need nvd ... Chorioamnionitis is not indication for c section. Hope m correct


Sent from my iPhone using Tapatalk
-plz explain why not uti,since cx closed,so fluid may be urin?
Reply With Quote Quick reply to this message
  #12  
Old 05-14-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 246
Threads: 18
Thanked 142 Times in 86 Posts
Reputation: 152
Default

clear fluid pooling in the vaginal fornix. The pH of the fluid is 7.5
this is alkalotic CLEAR AMiotic Fluid its definitively prom
Reply With Quote Quick reply to this message
The above post was thanked by:
um aala (05-14-2012)



Reply

Tags
ObGyn-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
USMLE Step 1 Exam Preparation - 30 Hours of FREE Videos - Clear Concepts, Higher USMLE Scores DrNajeebLectures USMLE Links & Free Ads 8 01-27-2013 11:40 PM
Conjunctivitis with clear discharge witecloud USMLE Step 2 CK Forum 5 02-12-2012 05:47 PM
Neck mass draining clear fluid after exercise ricko335 USMLE Step 1 Forum 3 10-04-2011 02:54 AM
Migraine (Abortive) therapy in a pregnant in the last trimester docoftheworld USMLE Step 2 CK Forum 7 06-01-2011 10:07 AM
27 yo with vaginal bleeding khushboo USMLE Step 1 Forum 6 01-26-2011 08:24 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)