Week 2 Discussion Forum

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #1 Maria, 49-year-old female, annual exam.

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnoses, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

In your peer replies, please reply to at least one peer who chose a different case study.

1. Tinais a married 25-year-old female who presents for her annual physical exam.  She is G1P0 with a history of SAB at 7 weeks EGA one year ago. Her LMP was 2 weeks ago and she reports regular 3-day menses every cycle.  She and her husband have used coitus interruptus as their primary method of birth control during the first two years of the marriage, but now they do not use any form of birth control because they would like to start a family.  Tina’s last Pap was 3 years ago and WNL.  She denies any significant medical history or health problems.  She drinks 2-3 glasses of wine most evenings with dinner and smokes tobacco cigarettes “recreationally” which she describes as “mostly on weekends when she is with her friends.” She denies any illicit drug use and does not take any medications. Her pregnancy test is negative and her vital signs are all WNL.

• What will you perform and order during this visit, and why? 
• What medical, social, and habits history and patient education are important during this visit?

Please refer to evidence-based guidelines to support your decision-making.

2. Ellenis a 35-year-old female whose latest Pap smear result reports HSIL with positive HPV.  Ellen reports no h/o of STIs or previous abnormal Pap smear results. She had only two previous Pap tests 7 and 14 years ago.  Ellen is G1P0 with a TAB at age 25.  She and her partner are undecided whether they want to have children.  She has been monogamously married to a female partner for the last 5 years, but she considers herself bisexual and has previously engaged in sexual activities with males and females.  Ellen denies any significant medical history or current health problems. Her LMP was 5 days ago and her VS are WNL.  Her BMI is 24.7.  Her pregnancy test is negative.

• What additional history do you need to ask this patient, and why?
• Explain Ellen’s Pap smear results (pathophysiology) and the action(s) that will be taken next to follow up this abnormality, including patient education (explain the procedure to the patient).

Please refer to evidence-based guidelines to support your decision-making.

3. Tracyis a 13-year-old female whose mother brings her to the clinic for her annual physical exam (PE). Tracy experienced menarche at age 12 and her menses has not yet become regular. It sometimes comes randomly or 1 or 2 months apart. Tracy’s mother says she is concerned about this and wants to know if this is normal and when Tracy’s periods might normalize. Tracy’s breast development and pubic hair development are appropriate for her developmental stage. Tracy says she is not and has never been sexually active and has no immediate future plans to become sexually active. Her pregnancy test is negative. All of her vital signs are WNL. A review of Tracy’s medical records indicates Tracy has not had the HPV vaccine. 

• Please describe the components of the PE that you will perform for Tracy.
• Describe the information and recommendations that will be provided to Tracy and her mother.

Please refer to evidence-based guidelines to support your decision-making.