GYNAECOLOGY MASTER THE CHAMBER LEUKORRHOEA oe Aarge for 1 pv dis Usually increases before vib: FF soemal secretion Y Nootber abnormality 1 igeculam examination? To Fer or vaginal pathology cuvial oF tigations 1 AVIA If>30 years 2. RAS:1F>30 yea ‘VAGINAL CANDIDIASISMINILIASIS o? P/V discharge for Iritaing Foul smelling Dysparcunia Py Thick and profuss/scent secretion: + oul smelling: ~ 1 VIA 2 Urine RE 1. Maintain ereonal hygiene 2 Wash peivate parts wih ke Use cotton undergarments __.| | eageaaat 401 Sone Tab. Abendaile tm 9 Te Advice: a ome Maintain personal yiene WS pte pero wih ke 3. Use cata Assure thats somal pysilogy Pill user may have to stop the pil Te Tab. Oraidrole Sbomg OHA 3 days Cap. Flucoracoe 150mg Tab weekly for 6 weeks Gynomix vaginal suppository [Only for ‘married womand 1 tik PV at night -12 nigh itching present: Tab, Fevofemadine 120mg o-ted Wivritaton present | Cream. Hydrocoriosene 12+ Miconszole m | Apnly loci-18 days Fusband should be teated with aystatin cinment locally after each sct of coitus. 7 chys SignatureOBSTETRICS AND GYNAECOLOGY Po [RS [PF atregs for husband ony Ip 2. Fover for 1041-14 days, : ‘la = [Rae PvE “There may be cervical motion teriomess Urine endemess and adnexal tenderness Tab. Ornidazole £00 1>0+1(A/MD- 5 days co “ieee ra Se tai) 4 VIA Gf>30 years) Teimonium meth sulpateSomy T+1+1- If pain present 2 " PO srt fisting cea | ag ¥ ‘Patient may-be toxic with high grade fever, vomoting and abdominal dist Insich condition hosptaliction is necessary GENRALIZED WEAKNESS/RODYACHE, OC R Le 1 Non specific generalized weakness | 7 min B Complex | cor body acke tor Investigations: 1. CBs 2. RBS 3. S.TSH:0n3 day of menstruation 040411 months acid+Zine Advice: months 1. Eatregular and balanced diet 2 Brereite regularly for 30 ins Signature 30 MASTER THE CHAMpeR DPOCAL HURSING SENSATION of popy (GENERALIZI ie urning sensation of Gerla burning tbody | Tab. vu tenes 1051-1 ods savestgations RBS. "isan symptom, ‘ mettne pecaige M a8 tema POST PONDING MENSTRUATION a Ft_wan's 10 pest pond ber| Tab, Noetierans etiod PRIMARY AMENORRHOFA ey Te ietinas pT Icrypromenorrhoea present or not FSH, Li, testosterone on 3” day of| Serum prolactin USG of W/A with special etention to 6 361 menstruation for certain prod a 1“1- Se fe eg = dite of mesrustion and contig dened SignatureOnSTETRE Ra, oe eee te Tab, Norethisterone Sng | fern 1181-2 dy ten tn yy Tr rypee co | Repeat he cyte fry 2. vscotWa | 3, $. Testosterone: : On 3" day of | Sign, ‘menstruation oni) 4, Srrocin SFSHLHOa3*dayofmensuaion | DYSMENORRHOFA ji ce a 1. LAP ing 13 cays of |b. Metonamic acta soomg rear | 1-tilm-t*3days of meet Investigations USGotWAa Cup. Omeprazole 20mg HOB "3 dye 6 mention Advice Signer 1 Hotsamprson oer abdomen | 5 2, Drnkpleny of ser SManwinmensmctenee | PUBERTY MENORHUAGIA ena or [Re 1. Paticnis in pera ope | Duting menstruation S Heppeeatmalidngee [Ta tenn et s0ome Frolsgsdiensnalbieting | sare sin Fer andominal examen HiinaD Cp, Omeprazole 20mg aviation: TCHAD days 1. CBC : a B USE =EWA with special atemin'o | Cap Tranannc a 00 pelvic oan MPa. saaye a. Brer | 4 s tsi | Tap, trontvoesetd+Zine Advice J or1:0(91)-3menns 1 Maina menstrual clear 2 Avoid any borane coting dug ‘smichas possible siguatwre Reassurance | a 2 NB lffomone eaining dag i acccciy Hens 30 SECONDARY AMENORRHEA ICS AND GYNAECOLOGY th progesterone only drugs [OF requir menstruation Weis sin Pie BB. rates errors pees x Gear data et J ee When a patient with P Tab, ZinctFolic acid O-0+1-3 months Advice Coit yaltemative day from 9* to 17* day of mens cycle HIRSUTISM OE: 1. Excessive facial or body hair Investigations, 1. 'S.FSI1, LH, prolactin : On 34 day 2 S testosterone at 3" day of menstrual cycle Ry, Tab. Spironolactone Som, 10:16 moots Refer to: Endocrinologist Signatie 36)OBSTETRICS AND GYNAECOLOGY 1. Excessive per vaginal bleeding fr Sug 2 Pain in lower abdomen dung smenstvation then, [+141 $0 258 : menstruation for 3 months Jnvestigations: 1. USG of WA 2 Vidor PAP smear ‘Tab. Mofonamc Acta 5 38 ts T+141(@/m)-5 days Advice: Cap. Omeprazole 20mg pak | cca sdays 2. Eat iron containing food THAIS days Tab. ron+Felic acid+Zine OF1+0(A/M)- 3mmonths sympiom int resolved: Rear 6 gasecologin FIBROID UTERUS = 1. Excessive pec vaginal bleeding for Hatem: 2. Painin lower sbdomen ‘Tab. Uipriatal Smg 0*04)-3 months on: | Anscnuis | Tab. Mtefenamic Acia Sv0mg Haralson: 12/14 wets size, | 1*1+1(on)- 3 days fm, mobile side wo side Cap. Omeprazole 20n Rx history: 1/0 blood trnsfsion HOH(BIM)-5 days Investigations: | Cap. Tranexamic acid Soom 1 cHC TH+ days 2 UsGorwa | 3. Vidor PAP smear | Advice | 1 DO TVS after 3 months and come | loflov urn besse ih er Omg Cap. Tranexamic acid 500mg MASTER THE CHANayen, i Rar seri ir see! Ne ee GA pen 1 kas, 5 creatinine TSH HBshy 2 3 4 5. Bloc Pt Bowing ad Fhng 1 4 9 Fea. ARPA sew cy 50 yay ADENOMYOSIS OC. Usually >40 years of age ina metres 1 eeepc ope any | 3} ene cares ieceaton | aa ie Cap ocr ciara ee ‘Cap. Tranexamie acid epi Aha) a 6 13H 1 Cotte be Rar 7. VIA or PAP smear 2 Repeat TVS Refer o gynaecologist after advising investigation for GA fitness: Above 1 RBS 2 S.creatinine 3 TSH 4B, 6 Blood grouping and Rb typi TVs Eca 8 CXRPA view 9. Echocardiography: if>$0 yearsconsrerni ‘OVARIAN CYST (Tiny: Few mun) ICS AND GYNABCOLOGY During menstrwation; | Tab, Metoamic Ae Soong MASTER THe OVARIAI 1 shdominal pin fr BE we i “ein. Sve Te eee er booed ' 4p. Omeprazole 20mg ai Sacre ] 10+ 5 days as in in eon mobili | fcntieso \ Cap. Tranexamic aia st mate } iecsce “ ees | | meta | Follow up 1 er Doppler USG ovarian ase [ 1 Uamaried 16 of pis op y caiss | 2 Marcia: TVS aner sous 3. wi | iia ee 6,_Inv for GA fines ee OVARIAN CYST (3-7em) DYSPAREUNIA TE Tab. Drospirenone¥Fihiaylestraaiar Ke 1. Loveraboinal pain fe 04041 rom I" day of menstsien 1. Princo ct for KY ty 2 Lamp over abdomen App Before each cotal at Tab. Teimonium meth sulpate som Investigations: Investigations: +141: pain present : 1. USC of W Signtare 1, USGofWA: In uamaried MIA 2 TVs: tfmared Cap. Omeprazole 20mg essere: on 3. VIA: 1230 year ifage HGH BN tracy present 4 caine signtere 5 cans PRURITUS VULVAE 6 10H | 3 GE iw GO eting in vulra ub ceam Follow up: HIVE: To detect any visible lesion 0 Clots propionate 005% Je Wespatris: USC ofpevic organs wit special attention to ovaries Investigations Apply ally BD- 2. Marcicd: TYS after S month Ih Mictoopic eaminaton ofasgal = a ImauopishnsEsegmacan , cae ‘Sig Refer ta gynaecologist I sin increases 3 che Ate eee eee c te eee ib: FBS, ar 1 ote ing andeigaments © scr | © petra of ction Li Shel Re 7 $. Biopsy Intong standingeases | 361OG 1. Feeling of blosting 2 Body ache 4. Breast tenderness 4 Headache 3. Feet cramming 6 Emotion insiabiliy Diagnosis is made by excluding medical oy psychiatric csorders Advice: 1 Daily charting of symptoms far 2 mons 2. Dietary modifications 3 Regilar exercise 4. Counseling OBSTETRICS AND OYNACOLOGY PREMENSTRUAL SYNDROME (PMS) m Tab, Pyridoxine 25m HLT 14 days (Dung tetea, hase) Tab Mafenamic acid S00mg 1M Dating symptom Tab. Spironolactone 10mpiday bolatcdness,imitabit ity, wel sain, breast tenderness, ‘ Tab. Faoretine 20m, O+0+1-2 weeks. : | Habove measures fl Mabove measures fal: [F-Metrosgeesetcrene 10mg | very 21 days 11*1-9 months with 7 days intents fer | —____Sigeanr| UTERINE PROLAPSE Ge = 1. Something coming down pr vagina for. Investigations 1. cae 2 RBs 3. S. creatinine 4 Ts 5. IDsAg 5. Blood grouping and th typing & Blood pou ping 8 ECG 9. CXRPA view 1 368 | Behocanogapty: 250 yeas ee al ~ AW ie aa Tab. Cipreftexacin 500mg | Lit: Pas Tab. Metronidazole 400mg HEEL Say ‘Vaginal pack | Refer topyasecologn Signatur | Invest sc of WA VIA or PAPsmear TSH 4 sconfirmed: Do GA fitness MASTIRTHE CHASneR, Cacravne ———_ in Vali Ria 1. ea sting te O81 a sh onan resp IL VIA or PAP positive: Colposcopy 0140.44). Senta Refer eyaaeolgit sts = EARLY MENOPAUSE —— Rx, Silage <40 years wih a Tab, Vitamin B Complex Pecan ores. mot Menstrual history: LMP: 4 Drog history: Tab. Normens | Ta Calciom carbonate soomg ee (0+140-3 months: My tSsH Sates 2 SHU MENOPAUSE ® oe ; 1. Hot fuses and night sweats Tah, Calan 100mg 2. Dryness of vagina Gr0+I-3 mons 3. Set incontine | unr itsccsry 4 Moot “cnes 26 an Advice: depression, insomnia Bes 1 Tae adequate fits an vege levetgciee Dyin i ude 1 At2-3 mont then 6 monthly 2. Yearly mame serum eseadiol apky, PAP smear, pele SG, 03 OBSTETRICS AND GYNAECOLOGY CONVENTIONAL HRT ingle therapy with estrogen In hysterectomized patie Tab. Estriol Img 0+0+1- Continue Or, Tab. Conjugated oestrogen 0.625mg O+0+1- Continue ¥ Firstly, prescribe it for 1-25" day then off for 5 days. Contin ¥ If symptoms present, then take continuously In intact uterus: Combined therapy estrogen + progeesterone ‘Tab, Estriol Img 0+0+1- Continue Tab. Norethisterone 5 mg 0+0+1/2- 13" 25" day- Continue If conventional HRT is contraindicated: Tab, Tobolone 2.5mg 0+0+1- 3 months Cream. Estriol 0.10% Apply daily for 3 weeks then twice dai ly for 3-4 weeks, Treatment with tibolone: Tz astural menopause: After 12 months of last natural blee In artificial menopause: Immediately In case of HRT ~ Estrogen only: After with, ¥ Sequential HRT: After progestero Continuous HRT: Anytime awal bleeding Ue this eye