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DR HOUSE CASE SERIES β€’ 100 CASES

🀰 Obstetrics & Gynaecology

One hundred clinically important OBG mysteries told as stories. The title gives you a twist, not the answer. Follow the clues, challenge the dangerous mimic, and reveal the diagnosis only on the final page.

Cases 1–2: FREE showcase cases. Cases 3–100: πŸ”’ Premium. An active Medicine β€” Dr House Case Series subscription unlocks this complete OBG collection FREE as bonus access, with no separate OBG purchase required.
CASE 01 β€’ Early Pregnancy

The Scan Was Empty, but Her Abdomen Wasn't

Seven weeks of amenorrhoea, unilateral pelvic pain, shoulder-tip pain and a brief collapse; the pregnancy test is positive, but transvaginal ultrasound shows no intrauterine sac and free fluid.

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CASE 02 β€’ Antepartum Haemorrhage

The Bleeding Was Painless. The Danger Wasn't

At 34 weeks she develops sudden bright-red vaginal bleeding without abdominal pain; the uterus is soft and non-tender and the fetus remains longitudinal.

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CASE 03 β€’ Antepartum Haemorrhage

The Pain Came Before the Blood

A hypertensive woman at 36 weeks develops abrupt constant abdominal pain, scant dark bleeding and a tense tender uterus; fetal heart tracing deteriorates.

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CASE 04 β€’ Hypertensive Disorders

Her Headache Ended in a Seizure

At 35 weeks, severe headache, visual flashes and epigastric pain are followed by a generalized tonic-clonic seizure; BP is 178/116 mmHg.

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CASE 05 β€’ Hypertensive Disorders

The Platelet Count Changed the Delivery Plan

A 32-week pregnant patient with hypertension reports nausea and right-upper-quadrant pain; platelets fall, AST rises and hemolysis markers become abnormal.

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CASE 06 β€’ Preterm Birth

The Water Broke, but Labour Never Started

At 31 weeks she notices a sudden gush followed by persistent clear leakage, without contractions or fever.

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CASE 07 β€’ Preterm Birth

The Cervix Was Changing Too Early

At 30+5 weeks she develops regular painful contractions; the cervix is progressively shortening and dilating.

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CASE 08 β€’ Fetal Medicine

The Baby Was Growing, Just Not Enough

Serial fundal height lags and ultrasound shows estimated fetal weight below expected centiles with abnormal umbilical artery Doppler.

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CASE 09 β€’ Gestational Trophoblastic Disease

The Pregnancy Looked Too Big for Its Dates

At 12 weeks she has recurrent bleeding, severe vomiting and a uterus larger than dates; Ξ²-hCG is strikingly high and ultrasound is abnormal.

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CASE 10 β€’ Early Pregnancy

The Vomiting Became a Metabolic Emergency

Nine weeks pregnant, she cannot retain fluids, has lost weight, is tachycardic and ketotic with hypokalaemia.

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CASE 11 β€’ Puerperium

The Fever Began After the Baby Went Home

Three days after cesarean delivery she develops fever, lower abdominal pain, uterine tenderness and foul-smelling lochia.

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CASE 12 β€’ Postpartum Haemorrhage

The Uterus Was Soft and the Blood Kept Coming

Minutes after delivery, brisk bleeding continues; the uterus is enlarged and boggy while the placenta appears complete.

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CASE 13 β€’ Placental Disorders

The Placenta Would Not Let Go

After a pregnancy complicated by low anterior placenta over a prior cesarean scar, attempted placental separation produces heavy bleeding and no clean plane.

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CASE 14 β€’ Intrapartum Emergency

The Head Delivered. Then Everything Stopped

The fetal head delivers and retracts against the perineum; gentle axial traction does not deliver the shoulders.

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CASE 15 β€’ Intrapartum Emergency

The Heart Rate Fell the Moment the Membranes Ruptured

Immediately after rupture of membranes, fetal bradycardia appears and a pulsating cord is felt below the presenting part.

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CASE 16 β€’ Intrapartum Emergency

The Scar Hurt Before the Monitor Changed

During TOLAC she develops sudden severe pain, fetal bradycardia and loss of station with maternal tachycardia.

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CASE 17 β€’ Postpartum Emergency

The Uterus Appeared Where the Placenta Had Been

After placental delivery she collapses with haemorrhage and severe pain; a red-blue mass is visible at the introitus and the fundus is not palpable abdominally.

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CASE 18 β€’ Early Pregnancy

The Pregnancy Continued Past the Positive Testβ€”But Not in the Uterus

She has painless early-pregnancy bleeding; ultrasound shows gestational tissue implanted within the cervical canal below the internal os.

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CASE 19 β€’ Early Pregnancy

The Scar Became the Implantation Site

A previous-cesarean patient has early bleeding; ultrasound shows a gestational sac embedded in the anterior lower uterine segment scar with thin myometrium toward the bladder.

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CASE 20 β€’ Gestational Trophoblastic Disease

The Pregnancy Test Stayed Positive After the Pregnancy Was Gone

Weeks after molar evacuation, Ξ²-hCG plateaus/rises instead of falling; she may have irregular bleeding but little else.

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CASE 21 β€’ Medical Disorders in Pregnancy

The Itch That Arrived Without a Rash

Third-trimester nocturnal pruritus of palms and soles without primary rash, with elevated bile acids.

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CASE 22 β€’ Maternal Medicine

Her Breathlessness Wasn't Just Pregnancy

Sudden dyspnoea, pleuritic pain and tachycardia with hypoxaemia in pregnancy or puerperium.

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CASE 23 β€’ Maternal Medicine

The Chest Pain Came Five Days After Delivery

Early postpartum severe chest pain with ischemic ECG/troponin rise in a woman without typical atherosclerotic risk.

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CASE 24 β€’ Maternal Medicine

The Breathlessness Came With a Failing Heart

Late pregnancy or early postpartum progressive dyspnoea, orthopnoea, oedema and reduced LVEF without another cause.

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CASE 25 β€’ Obstetric Infection

The Fever Wasn't the Only Threat to the Fetus

In labour she develops fever with fetal tachycardia, uterine tenderness and purulent/malodorous fluid.

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CASE 26 β€’ Puerperium

The Leg Swelled After the Cesarean

Post-cesarean unilateral leg swelling, tenderness and asymmetry without another explanation.

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CASE 27 β€’ Puerperium

The Headache Disappeared When She Lay Flat

Severe postural headache after neuraxial anaesthesia, worse upright and relieved supine, with neck symptoms but no focal deficit.

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CASE 28 β€’ Puerperium

The Headache Wasn't From the Epidural

Postpartum progressive headache becomes non-postural and is followed by seizure/focal deficit.

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CASE 29 β€’ Perinatal Mental Health

The Mother Who Stopped Sleeping

Within days of delivery she becomes sleepless, disorganized, grandiose and begins hearing voices about the baby.

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CASE 30 β€’ Perinatal Mental Health

The Sadness That Lasted Beyond the Baby Blues

Weeks after delivery she has persistent low mood, anhedonia, guilt and impaired bonding/function.

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CASE 31 β€’ Endometriosis

The Pain Returned Every Month

Progressive dysmenorrhoea, deep dyspareunia and infertility with cyclical pelvic pain.

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CASE 32 β€’ Benign Gynaecology

The Uterus Felt Like a Tender Globe

Heavy painful periods with a uniformly enlarged tender boggy uterus in a multiparous woman.

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CASE 33 β€’ Benign Gynaecology

The Heavy Periods Hid a Distorted Cavity

Heavy cyclic bleeding and infertility with a focal intracavitary lesion distorting the endometrium.

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CASE 34 β€’ Pregnancy Complication

The Fibroid Outgrew Its Blood Supply

Pregnant patient with known fibroid develops localized severe pain, low-grade fever and tenderness without peritonism.

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CASE 35 β€’ Gynaecologic Emergency

The Ovary Twisted Before the Scan Looked Dramatic

Sudden severe unilateral pelvic pain with nausea/vomiting and an adnexal mass; Doppler flow may still be present.

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CASE 36 β€’ Gynaecologic Emergency

The Cyst Ruptured at Midnight

Sudden unilateral pelvic pain, often mid-cycle, with free pelvic fluid and variable haemodynamic impact.

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CASE 37 β€’ Pelvic Infection

The Fever Built a Mass Behind the Uterus

Fever, pelvic pain and cervical/adnexal tenderness with a complex adnexal mass after PID symptoms.

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CASE 38 β€’ Pelvic Infection

The Pain Started After a New Partner

Bilateral lower abdominal pain, dyspareunia and abnormal discharge with cervical motion tenderness.

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CASE 39 β€’ Abnormal Uterine Bleeding

The Bleeding Had No Structural Explanation

Irregular unpredictable heavy bleeding with no focal structural lesion, often around adolescence or perimenopause.

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CASE 40 β€’ Gynaecologic Oncology

The Spotting After Sex Was the Clue

Persistent postcoital bleeding and watery discharge with a friable cervical lesion.

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CASE 41 β€’ Gynaecologic Oncology

The Bleeding Returned Years After Menopause

New postmenopausal bleeding in an obese diabetic woman after years without menses.

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CASE 42 β€’ Gynaecologic Oncology

The Bloating Wasn't Indigestion

Months of persistent bloating, early satiety and increasing abdominal girth with ascites/adnexal mass.

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CASE 43 β€’ Vulval Disease

The Vulval Itch Left a White Map

Chronic intense vulval itch with porcelain-white plaques, architectural change and fissuring.

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CASE 44 β€’ Vulval Disease

The Lump Made Sitting Impossible

Acute severe pain with a fluctuant posterolateral introital swelling and difficulty walking/sitting.

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CASE 45 β€’ Adolescent Gynaecology

The Periods Never Came, but Puberty Did

Primary amenorrhoea with normal breasts/pubic hair and a shortened vagina; uterus is absent on imaging.

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CASE 46 β€’ Adolescent Gynaecology

The Monthly Pain Had No Exit

Teenager with primary amenorrhoea, cyclical pain, urinary symptoms and a bulging bluish hymenal membrane.

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CASE 47 β€’ Reproductive Medicine

The Periods Vanished After Curettage

Secondary amenorrhoea and infertility begin after postpartum curettage for retained products.

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CASE 48 β€’ Endocrine Gynaecology

The Acne and Irregular Cycles Shared One Cause

Oligomenorrhoea, acne and hirsutism with weight gain and no rapid virilization.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 49 β€’ Endocrine Gynaecology

The Milk Came Without a Pregnancy

Amenorrhoea/infertility with galactorrhoea and headaches but a negative pregnancy test.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 50 β€’ Infertility

The Tubes Remembered an Old Infection

Two years of infertility with remote PID and no ovulatory symptoms; semen analysis is normal.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 51 β€’ Reproductive Medicine

Three Losses Pointed to the Shape of the Uterus

Recurrent early pregnancy losses with otherwise unrevealing work-up; 3D ultrasound shows a septate cavity.

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CASE 52 β€’ Multiple Pregnancy

Two Fetuses, One Placenta, Unequal Fluid

Monochorionic diamniotic twins develop severe oligohydramnios in one sac and polyhydramnios in the other.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 53 β€’ Fetal Medicine

The Antibody Screen Predicted the Fetal Anaemia

Rh-negative mother has clinically significant antibodies and fetus develops rising MCA peak systolic velocity.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 54 β€’ Fetal Medicine

The Baby Was Too Large for the Pelvis

Diabetic pregnancy with estimated fetal weight far above gestational centiles and concern for birth trauma.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 55 β€’ Medical Disorders in Pregnancy

The Sugar Test Changed the Rest of Pregnancy

Routine screening shows hyperglycaemia despite few symptoms; fetal growth begins accelerating.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 56 β€’ Medical Disorders in Pregnancy

The Thyroid Was Racing With the Pregnancy

Weight loss, tremor, palpitations and goitre with suppressed TSH and elevated free T4 during pregnancy.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 57 β€’ Medical Disorders in Pregnancy

The Anaemia Wasn't Iron Deficiency

Microcytic anaemia persists despite iron, ferritin is normal and family/ethnic history raises haemoglobinopathy risk.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 58 β€’ Medical Disorders in Pregnancy

The Fever and Flank Pain Threatened Two Patients

Pregnant patient with high fever, rigors, flank pain and CVA tenderness becomes tachycardic.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 59 β€’ Surgical Disorders in Pregnancy

The Appendix Moved as the Uterus Grew

Pregnant patient develops progressive right-sided abdominal pain, anorexia and focal tenderness with equivocal ultrasound.

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CASE 60 β€’ Surgical Disorders in Pregnancy

The Gallbladder Chose the Third Trimester

RUQ pain, fever and vomiting after meals with sonographic gallstones and wall thickening.

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CASE 61 β€’ Hypertensive Disorders

The Pressure Was High Before Twenty Weeks

Hypertension is documented before 20 weeks and persists, with later concern for rising proteinuria and symptoms.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 62 β€’ Hypertensive Disorders

The Blood Pressure Rose, but the Organs Were Still Quiet

New hypertension after 20 weeks without proteinuria or severe features, with reassuring labs and fetal status.

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CASE 63 β€’ Hypertensive Disorders

The Protein Was Only One Part of the Story

New hypertension with severe-range BP, headache/visual symptoms or organ dysfunction after 20 weeks.

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CASE 64 β€’ Fetal Surveillance

The Baby Stopped Moving

A previously active fetus becomes markedly less active; maternal perception is clearly different from baseline.

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CASE 65 β€’ Intrapartum Fetal Surveillance

The Monitor Lost Its Variability

During labour the tracing develops persistent bradycardia or recurrent late decelerations with reduced variability.

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CASE 66 β€’ Labour Complication

The Contractions Were Too Strong to Be Safe

Oxytocin infusion is followed by >5 contractions in 10 minutes and fetal heart abnormalities.

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CASE 67 β€’ Labour Dystocia

The Labour Stopped Progressing

Despite adequate time and contractions in active labour, cervical dilation stops progressing.

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CASE 68 β€’ Malposition

The Head Was Down, but Facing the Wrong Way

Prolonged second stage with severe back pain and fetal head remaining occiput posterior.

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CASE 69 β€’ Malpresentation

The Breech Was Discovered in Labour

In labour, examination reveals sacrum/feet rather than vertex in a term singleton.

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CASE 70 β€’ Placental/Fetal Vessels

The Cord Was Wrapped Around a Vessel, Not the Neck

After membrane rupture there is painless vaginal bleeding followed immediately by fetal bradycardia.

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CASE 71 β€’ Third Stage Complication

The Placenta Stayed Inside After Thirty Minutes

Placenta fails to deliver after the expected third-stage interval, with or without haemorrhage.

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CASE 72 β€’ Postpartum Haemorrhage

The Bleeding Came From a Firm Uterus

Heavy postpartum bleeding continues despite a firm well-contracted uterus.

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CASE 73 β€’ Postpartum Haemorrhage

The Blood Wouldn't Clot

Abruption/PPH/sepsis is followed by diffuse oozing, low fibrinogen, thrombocytopenia and prolonged coagulation tests.

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CASE 74 β€’ Early Pregnancy Infection

The Fever Followed an Unsafe Abortion

After attempted abortion she develops fever, pelvic pain, foul discharge and shock with retained intrauterine material.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 75 β€’ Early Pregnancy Loss

The Cervix Was Open but the Pregnancy Hadn't Passed

Early pregnancy bleeding and cramping with an open cervical os but products not yet expelled.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 76 β€’ Early Pregnancy Loss

The Ultrasound Showed a Pregnancy That Had Quietly Stopped

Pregnancy symptoms fade; ultrasound shows embryo/fetus without cardiac activity meeting diagnostic criteria, with little bleeding.

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CASE 77 β€’ Early Pregnancy Loss

The Bleeding Continued Because Something Remained

Heavy bleeding and cramping follow partial tissue passage; ultrasound/clinical exam suggests retained products.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 78 β€’ Early Pregnancy

The Pregnancy Was in the Tube but Hadn't Ruptured

Stable patient with mild pain, positive pregnancy test and definite small adnexal ectopic without rupture.

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CASE 79 β€’ Fetal Arrhythmia

The Fetal Heart Was Too Fast for Too Long

Persistent fetal heart rate >200–220/min with possible hydrops on ultrasound.

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CASE 80 β€’ Amniotic Fluid Disorder

The Fluid Around the Baby Kept Increasing

Uterus measures large for dates with breathlessness; ultrasound shows excessive amniotic fluid.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 81 β€’ Amniotic Fluid Disorder

The Fluid Around the Baby Was Disappearing

Fundal height lags and ultrasound shows low fluid with intact or uncertain membranes.

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CASE 82 β€’ Cervical Disorders

The Cervix Opened Without Contractions

Recurrent painless second-trimester loss or ultrasound shows progressive cervical shortening/dilation without labour.

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CASE 83 β€’ Post-term Pregnancy

The Pregnancy Reached Forty-One Weeks and Kept Going

Pregnancy continues beyond expected term with concern for placental ageing and declining fluid.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 84 β€’ Postoperative Obstetrics

The Scar Opened After the Cesarean

Several days after cesarean she develops wound pain, erythema, discharge and fever; deeper separation is suspected.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 85 β€’ Puerperium

The Breast Became Red and the Fever Spiked

Breastfeeding mother develops focal wedge-shaped breast erythema, pain and fever.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 86 β€’ Puerperium

The Breast Lump Became Fluctuant

Mastitis symptoms persist and a tender fluctuant mass develops despite antibiotics.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 87 β€’ Puerperium

The Pain Was in the Perineum, but the Fever Was Systemic

Postpartum severe perineal pain, malodorous discharge, wound breakdown and fever.

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CASE 88 β€’ Gynaecologic Emergency

The Pelvic Pain Had No Fever and No Pregnancy

Known fibroid with sudden focal pelvic pain and tenderness, pregnancy test negative, adnexa separate on imaging.

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CASE 89 β€’ Secondary Dysmenorrhoea

The Period Pain Began Years After It Should Have

New progressive dysmenorrhoea in adulthood with dyspareunia or heavy bleeding rather than lifelong stable cramps.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 90 β€’ Gynaecologic Infection

The Tampon Became the Missing Clue

High fever, hypotension, diffuse rash and multisystem illness with tampon use/retained vaginal foreign body.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 91 β€’ Family Planning

The IUD Strings Disappeared

IUD strings are no longer visible and she has pelvic pain or an unexpected pregnancy concern.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 92 β€’ Family Planning

The Pregnancy Happened With an IUD Still Inside

Positive pregnancy test with IUD present; first question is pregnancy location.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 93 β€’ Contraception

The Pill and the Migraine Changed the Risk

Woman requesting combined hormonal contraception describes focal neurologic aura before migraines.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 94 β€’ Endocrine Gynaecology

The Hot Flushes Came at Thirty-Eight

Amenorrhoea, hot flushes and infertility before age 40 with repeatedly elevated FSH.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 95 β€’ Acute Gynaecology

The Bleeding Was Heavy Enough to Change Her Pulse

Non-pregnant patient has torrential uterine bleeding, tachycardia and symptomatic anaemia.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 96 β€’ Gynaecologic Emergency

The Pain Was Pelvic, but the Pregnancy Test Was Negative

Adolescent with abrupt unilateral pain and vomiting; pregnancy test negative and enlarged ovary on ultrasound.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 97 β€’ Gynaecologic Oncology

The Mass Grew Fast After Menopause

Postmenopausal woman develops enlarging uterine mass, bleeding and pressure symptoms with atypical imaging.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 98 β€’ Gestational Trophoblastic Disease

The Mole Returned as Breathlessness

After molar pregnancy, rising Ξ²-hCG is accompanied by cough/haemoptysis or neurologic symptoms.

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CASE 99 β€’ Ovarian Disorders

The Ovary Was Large in Early Pregnancy for a Different Reason

Pregnancy ultrasound shows bilateral multicystic enlarged ovaries with high hCG state but no ovarian stimulation.

πŸ”’ PREMIUMOpen Mystery β†’
CASE 100 β€’ Reproductive Emergency

The Fertility Treatment Filled Her Abdomen With Fluid

After ovulation induction she develops abdominal distension, enlarged ovaries, ascites, haemoconcentration and dyspnoea.

πŸ”’ PREMIUMOpen Mystery β†’