Case study 1

Elaine Goodwin is a 38-year-old G5 P5 LC 6 presenting to your clinic today to discuss contraceptive options.  She states that she is not interested in having more children but her new partner has never fathered a child. Her medical history is remarkable for exercise-induced asthma, migraines, and IBS. Her surgical history is remarkable only for tonsils as a child. Her social history is negative for alcohol, tobacco, and recreational drugs.  She has no known drug allergies and takes only vitamin C. Hospitalizations were only for childbirth. Family history reveals that her maternal grandmother is alive with dementia, while her maternal grandfather is alive with COPD. Her paternal grandparents are both deceased due to an automobile accident. Her mother is alive with osteopenia and fibromyalgia, and her dad is alive with a history of skin cancer (basal cell). Elaine has one older sister with no medical problems and one younger brother with no reported medical problems.  

· Height 5’ 7” Weight 148 (BMI 23.1), BP 118/72 Pulse 68  

· HEENT (head, ears, eyes, nose, throat):  wnl (within normal limit)

· Neck: supple without adenopathy  

· Lungs/CV (cardiovascular): wnl  

· Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge  

· Abd (abdomen): soft, +BS (positive bowel sound), no tenderness  

· VVBSU (Vulvar vaginal bartholin skene’s uretha): wnl, except 1st degree cystocele  

· Cervix: firm, smooth, parous, without CMT (cervical motion tenderness)

· Uterus: RV (retroverted), mobile, non-tender, approximately 10 cm,  

· Adnexa: without masses or tenderness  

Based on the case study scenario provided, complete a comprehensive well-woman exam and critically analyze to focus attention on the diagnostic tests (include explanation of the tests you might recommend).

Include your differential diagnosis. Be specific and provide examples. Use your Learning Resources and/or evidence from literature to support your explanations.

Some questions to answer in your post:

1. What other information do you need?

2. What has she used in the past?  Why did she stop a method?  How many partners in past 12 months?  

3. What are her current cycles like?  

4. When was her last gyn exam and what were the results of the tests?   

5. Are her migraines with or without auras?  

6. What method has she considered. 

7. What are you next steps/considerations?

8. What teaching should you do?

9. What methods are appropriate for Elaine?