Chief Complaint
\n(CC)\t\t\u201cI have pain during intercourse and urination\u201d
\nHistory of Present Illness (HPI)\t\tA 19-year-old female reports to you that she has \u201csores\u201d on and in her vagina for the last three months.
\nDrug Hx\t\tShe tries to practice safe sex but has a steady boyfriend and figures she doesn\u2019t need to be so careful since she is on the birth control pill
\nFamily Hx
\nSubjective
\nstates \u201cI have sores and bumps on the inner creases of my thighs and pelvic area\u201d. \u201cThere is yellowish discharge from the sores that comes and goes
\nObjective Data
\nVS\t\ttemperature: 100.2\u00b0F; pulse 92; respirations 18; BP 122\/78; weight 156 lbs, 25 lbs overweight; height 5\u20323\u2033
\nGeneral\t\tpatient appears to have good hygiene; minimal makeup, pierced ears, no tattoos; well nourished (slightly overweight); no obvious distress noted
\nHEENT\t\tAtraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip.
\nLungs\t\twithin normal limits, appropriate lung sounds auscultated, clear and equal bilaterally
\nCard\t\tS1S2 without rub or gallop
\nBreast
\nINSPECTION: no dimpling or abnormalities noted upon inspection
\n\u2022 PALPATION: Left breast no abnormalities noted. Right breast: denies tenderness, pain, no abnormalities noted.
\nLymph\t\tInguinal Lymph nodes: tenderness bilaterally, numerous, 1 cm in size
\nAbd\t\ttender during palpation; the left lower quadrant was very tender during palpation; patient denies nausea or vomiting
\nGU\t\tlabia major and minor: numerous ulcerations, too many to count; some ulcerations enter the vaginal introitus; no ulcerations in the vagina mucosa; cervix is clear, some greenish discharge; bimanual exam reveals tenderness in left lower quadrant; able to palpate the left ovary; unable to palpate the right ovary; no tenderness; uterus is normal in size, slight tenderness with cervical mobility
\nIntegument
\nMS\t\tMuscles are smooth, firm, and symmetrical. Full ROM. No pain or tenderness on palpation.
\nNeuro\t\tNo obvious deficits and CN grossly intact II-XII<\/p>\n
What other subjective data would you obtain?
\nWhat other objective findings would you look for?
\nWhat diagnostic exams do you want to order?
\nName 3 differential diagnoses based on this patient’s presenting symptoms.
\nGive rationales for each differential diagnosis.
\nWhat teachings will you provide?
\nSubmission Instructions:<\/p>\n
Your initial post should be at least 500 words, formatted and cited in the current APA style with support from at least 2 academic sources other than your textbook. Your initial post is worth 8 points.
\nAdditional Subjective Data:
\nAsk about sexual history in more detail – number of partners, condom use, history of STIs
\nMenstrual history – last period, flow, cramps
\nReview of systems – dysuria, abnormal discharge, abdominal\/pelvic pain
\nAdditional Objective Findings:
\nPerform pelvic exam to inspect external genitalia and cervix under good lighting
\nTest vaginal discharge for pH, presence of clue cells on microscopy (Taussig, 2016)
\nDiagnostic Exams:
\nPerform wet mount of vaginal discharge to examine under microscope for presence of motile trichomonads (Taussig, 2016)
\nPerform nucleic acid amplification test (NAAT) for detection of Chlamydia trachomatis and Neisseria gonorrhoeae (CDC, 2019)
\nConsider culture for detection of bacterial vaginosis (BV) (Bradshaw et al., 2006)
\nDifferential Diagnoses:
\nTrichomoniasis – Presenting symptoms of vaginal discharge, dysuria and pelvic pain are consistent with this STI (CDC, 2022).
\nBacterial vaginosis (BV) – Presence of abnormal discharge, vaginal pH >4.5 and clue cells on microscopy suggest this diagnosis (Bradshaw et al., 2006).
\nCervicitis – Inflammation of the cervix can cause cervical discharge and may be associated with an STI such as chlamydia (CDC, 2019).
\nTeachings for the Patient:
\nImportance of adhering to prescribed treatment and avoiding sexual activity until completion to prevent reinfection and spread to partners (Taussig, 2016; CDC, 2022)
\nCounsel on safe sex practices like condom use and limiting new partners to prevent STIs (CDC, 2019)
\nRecommend following up in 1 week and as needed for resolution of symptoms (Bradshaw et al., 2006)
\nPlease let me know if you need any clarification or have additional questions. I have included references in APA format within the text as well as a reference list below.
\nBradshaw, C. S., Morton, A. N., Garland, S. M., Morris, M. B., Moss, L. M., Fairley, C. K., & Chen, M. Y. (2006). Aetiology of genital infections in women attending Melbourne sexual health services. Sexually transmitted infections, 82(2), 121\u2013125. https:\/\/doi.org\/10.1136\/sti.2005.017051
\nCenters for Disease Control and Prevention. (2019). Sexually transmitted diseases treatment guidelines. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports, 68(4), 1\u2013117. https:\/\/doi.org\/10.15585\/mmwr.rr6804a1
\nCenters for Disease Control and Prevention. (2022, May 5). Trichomoniasis – CDC Fact Sheet. Centers for Disease Control and Prevention. https:\/\/www.cdc.gov\/std\/trichomonas\/stdfact-trichomoniasis.htm
\nTaussig, L. M. (2016). Trichomoniasis. In L. M. Taussig & S. C. Landers (Eds.), A practical guide to pediatric and adolescent gynecology (pp. 121\u2013126). Springer International Publishing. https:\/\/doi.org\/10.1007\/978-3-319-25786-4_15<\/p>\n","protected":false},"excerpt":{"rendered":"
Chief Complaint (CC) \u201cI have pain during intercourse and urination\u201d History of Present Illness (HPI) A 19-year-old female reports to you that she has \u201csores\u201d on and in her vagina for the last three months. Drug Hx She tries to practice safe sex but has a steady boyfriend and figures she doesn\u2019t need to be […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4032,4029,4040,4034,4037,4033,4030,4041,4036,4035,4043,4039,4042,4031,4038],"tags":[3965,3711,3962,3710,3650,3681,3963,3964,3713,3712,2436,3325,3967,3966],"class_list":["post-10515","post","type-post","status-publish","format-standard","hentry","category-best-ideas-for-dissertation-topics","category-best-ideas-for-research-paper-topics-in","category-best-research-paper-topics-for-examples","category-best-thesis-topics-and-ideas-on-different-subjects","category-dissertation-topics-good-thesis-ideas","category-dissertation-topics-for-ph-d-and-thesis-ideas","category-dissertation-topics-for-students-in","category-research-titles-examples","category-research-topics-for-college-students","category-sample-thesis-titles","category-thesis-and-dissertation-ideas-for-research-topics-in-uk","category-thesis-topics-for-your-final-academic-project","category-thesis-topics-for-your-masters-degree","category-trending-dissertation-topics-ideas-for","category-undergraduate-dissertations-topics-examples-ideas","tag-cheap-essay-service-online","tag-dissertation-ideas","tag-essay-service-website","tag-essay-topics","tag-i-need-help-writing","tag-page-paper","tag-pay-for-essay-get-top-quality","tag-professional-to-write-my-essay","tag-research-paper-samples","tag-thesis-examples","tag-write","tag-write-a-paper","tag-write-my-essay-for-me-by-native-writer","tag-write-my-essay-no-plagiarism"],"_links":{"self":[{"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/posts\/10515","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/comments?post=10515"}],"version-history":[{"count":0,"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/posts\/10515\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/media?parent=10515"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/categories?post=10515"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/tags?post=10515"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}