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OBGYN Pamela Flowers

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Diagnosis – Ectopic pregnancy DDX – Endometriosis, tubo-ovarian abcess, Pelvic inflammatory disease, ovarian cyst, ectopic pregnancy, abortion, ovarian torsion, dysmenorrhea-primary Problem Stat... ement: ( Demographic description – chief complaint – Hx and PE key findings – risk factors ) Pamela Flowers is a 24 year old G0P0 woman presenting with abnormal vaginal bleeding and LLQ pelvic pain for 1 day. She has a history of dysparenuria on her left side. Gynecological exam shows tenderness and L- adnexal fullness (no mass) w/ enlarged + soft uterus. Patient has history of irregular periods. ( you just need a treatment plan ) CC: Pamela Flowers is a 24 year old G0P0 woman presenting with abnormal vaginal bleeding and LLQ pelvic pain HPI: The vaginal bleeding and pain started 1 day prior. Patient also describes dyspareunia 1 week ago, and has history of ‘irregular periods’ Meds: inhaler for asthma PMH: Pap smear + gyn exam 8mo ago normal – treated for chlamydia infection 3 years ago. SH: one current sexual partner, condoms for contraception. ROS: Only positive findings are seen in HPI Physical Exam: VS: Pulse – 104; BP – 108/60 RR – 14; T – 98.8F (37 C); SpO2 – 98% Gynecologic: Tenderness noted to bimanual exam. Left Adnexal fullness seen without mass. Uterus is enlarged and softened. ASSESSMENT/PLAN Test Results: • Human chorionic gonadotropin (hCG), plasma: Value consistent with 5-6 w normal gestation, suggest transvaginal ultrasound. • TVUS: high probability of left fallopian tube ectopic pregnancy • LFTs: Normal (allows her to be Methotrexate candidate) Management Plan • Methotrexate • Monitor b-hCG levels after 1 week of MTX. • If no improvement consider salpingostomy / salpingectomy ...............................................CONTINUED......................................... [Show More]

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