Presentation After a direct blow to or a fall onto the lateral shoulder with the arm adducted, the patient complains of shoulder pain increased by motion of the arm ( Fig. 95.1A ). An indirect mechanism of injury commonly involves…
Presentation A patient presents for evaluation of vaginal discharge, possibly with itching and/or irritation of the labia and vagina. Odor, dysuria, vague low abdominal discomfort, or dyspareunia may be present. Abdominal examination is benign, but examination of the introitus may…
Presentation A worried menstruating female presents with greater-than-usual bleeding, which is either off of her usual schedule (metrorrhagia), lasts longer than a typical period, or is heavier than usual (menorrhagia), perhaps with crampy pains and passage of clots. Bleeding is…
Presentation A female patient presents for evaluation after sexual contact. There was no barrier to prevent sexually transmitted infections (STIs) or pregnancy, or the barrier method being used was suspected to have failed (e.g., a condom broke or contraceptive pills…
Presentation A sexually active female, possibly with a new sex partner or multiple sex partners, presents with lower abdominal pain beginning with or soon after her last menstrual period. There may be associated vaginal discharge, malodor, dysuria, dyspareunia, menorrhagia, or…
Presentation Vaginal foreign bodies occur in both children and adults. The patient presents for care with a foul-smelling, bloody or brown purulent discharge, or pain. Children may insert a foreign body and not tell their parents or may be the…
Presentation A young female presents with crampy, laborlike pains that began shortly before or at the onset of the visible bleeding of her menstrual period. The pain is focused in the lower abdomen, low back, suprapubic area, or thighs and…
Presentation A patient presents for evaluation of severe vulvar itching that may be accompanied by edematous swelling. Occasionally there will be tenderness, pain, burning, and dysuria severe enough to cause urinary retention. The vulvovaginal area is variably inflamed, erythematous, and…
Presentation Patients may complain of perineal itching, burning, pain, and tenderness, although they are commonly asymptomatic, especially with cervical and vaginal involvement. Distinctive fleshy warts can be found on the external genitalia or anus ( Figs. 87.1 and 87.2 ).…
Presentation A female of reproductive age presents for evaluation of vulvar pain and swelling that has developed over the past 2 to 3 days. Pain is increased when walking and sitting. On physical examination in the lithotomy position, there is…