Mary, a 32-year-old, G0P0, female who identifies as lesbian, presents with c/o vaginal discharge that has a strong fishy odor
Mary, a 32-year-old, G0P0, female who identifies as lesbian, presents with c/o vaginal discharge that has a strong fishy odor
DUE APRIL 23
Choose one of the cases below for your report and include the following:
- A thorough understanding of the topic
- A critical assessment of all questions
- At least two differential diagnoses, if applicable
- At least two pharmacologic treatment modalities, if applicable
- A well-developed treatment plan
- A thorough patient education plan
The body of your paper needs to be 3-4 pages long. This does NOT include the title page and reference page. Papers that are more than 4 pages long will not be accepted. You must reference a minimum of two scholarly sources on your paper.
Use current APA format to style your paper and to cite your sources. Integrate your sources into the paragraphs and use internal citations pointing to evidence in the literature and supporting your ideas.
Be sure to allow time for editing and proofreading.
Review the rubric for more information on how the assignment will be graded.
Points: 140
Due: Sunday, 11:59 p.m. (Pacific time)
Case Study #1: Sexual Health, Gynecologic Care for Sexual and Gender Minorities
Mary, a 32-year-old, G0P0, female who identifies as lesbian, presents with c/o vaginal discharge that has a strong fishy odor. She has tried douching and over-the-counter remedies with no relief. She shares that she and her girlfriend use sex toys. She denies having sex with anyone else, but she says her girlfriend is bisexual and possibly has been with someone else. She says she has only had one pelvic exam when she was 20 years old, with a male physician, and she felt as though she had been raped. During the examination, he was rough and she could tell he did not like the fact that she identified as lesbian. She has not been seen since. She denies any health issues in her past, has never been pregnant, has never had sex with males, and has never had an STI, or at least she believes she has not. She also shares that she is very nervous but knew she had to come in.
1. Prior to your exam, how will you address her fear?
2. What other historical information will you obtain? On exam, her height is 5′ 8″, weight 165lbs, BP 118/76, breast exam negative, pelvic exam reveals thin homogenous, frothy green discharge pooling in the posterior fornix. Negative cervical motion tenderness, negative adnexal tenderness, and her uterus is normal size, shape, and contour with no tenderness on palpation. Her cervix is normal but bleeds easily with manipulation.
3. What are your differential diagnoses? What is your final diagnosis?
4. What additional tests will you order and why? 5. Based on your final diagnosis, what is your treatment plan? 6. What educational issues do you want to discuss with this patient.
Case Study #2: Gynecologic Abnormalities
Gladys, a 75-year-old woman, G5P5, presents for an annual exam and reports a “fullness” in her vagina. She notices her symptoms more when she is standing for a long time. This feeling is bothersome and is affecting her daily activities. She does not complain of urinary or fecal incontinence. She has not experienced any vaginal bleeding. Her past medical history is significant for well-controlled hypertension and chronic bronchitis. She has never had surgery. Pelvic exam reveals normal appearing external genitalia except for generalized atrophic changes. The vagina and cervix are without lesions. Relaxation of the anterior and posterior vaginal wall is noted to approximately one centimeter beyond the vaginal opening when she is asked to Valsalva. The cervix also descends to that level with Valsalva. The uterus is normal size. The ovaries are not palpable. No rectal masses are noted. Rectal sphincter tone is slightly decreased. 1. What are the most important support mechanisms for the pelvic organs?
2. What increases this patient’s risk for pelvic organ prolapse?
3. What are the different types of pelvic organ prolapse?
4. What are the steps in evaluating someone with prolapse?
5. What are treatment options you should discuss with this patient?
6. When is surgery indicated for prolapse?
Case Study #3: Gynecologic Abnormalities
Mrs. Jones, a 42-year-old, G3P3, presents with a history of abnormal bleeding and pelvic pain. She was well until approximately age 35, when she began developing dysmenorrhea and progressive menorrhagia. The dysmenorrhea was not fully relieved by NSAIDs. Over the next several years, the dysmenorrhea and menorrhagia became more severe. She then developed intermenstrual bleeding and spotting as well as pelvic pain, which she describes as a constant feeling of pressure. She also complains of urinary frequency. Her past GYN history is negative. Her surgical history includes 3 C-sections and a bilateral tubal ligation at age 30. Her past medical history is unremarkable. Her physical exam reveals a well-developed, well-nourished woman in no distress. Vital signs and general physical exam are unremarkable. Her abdominal exam reveals an irregular-sized mass extending halfway between the symphysis pubis and umbilicus deviated to the right of the midline. The vagina and cervix appear normal on inspection. However, the cervix palpates firm. The uterus is markedly enlarged and irregular, especially on the right side. The adnexae are not palpable. Labs drawn: Hgb. 10.3 Hct. 31.2%. Indices are hypochromic, microcytic. Serum ferritin confirms mild iron deficiency anemia. Pap test is negative and an ultrasound reveals multiple large intramural fibroids, filling the pelvis and extending into the lower abdomen. The ovaries are not visualized.
1. What are the likely causes for the mass?
2. What are your differential diagnoses? What is your final diagnosis?
3. What is the prevalence of leiomyoma in different populations of women?
4. Discuss the appropriate management of women with fibroids.
5. What are the indications for hysterectomy in women with fibroids?
6. What are nonsurgical treatment options for women with fibroids?
Requirements: 4 PAges
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