Reference no: EM133510035
Case Study: Missed Period
Juanita Morales is a 47-year-old G5. P5 LC 6, Hispanic female who presents to the office complaining of lower abdominal cramping, and urinary leakage for past day. She states the abdominal cramping, suprapubic, started several hours ago, is sharp, intermittent, and getting
more frequent and painful. She tried Motrin but states it did not help. She had a UTI years ago and it was like this, except the incontinence. She has been more tired for the past several months. She relates she stopped getting her period about 8-12 months ago, and relates her
menopause was easy. She relates no medical or surgical history. She has no known drug allergies and takes no medications. Social history is negative for alcohol, tobacco, and recreational drugs. Her last exam was several years ago.
Vital signs: temperature 99.1, BP 140/ 82, pulse 88, respirations 12. Height is 5' and weight 235 lbs. (BMI 45.89).
A clean catch urine was obtained, and the urine dipstick showed SG 1.010, trace blood, neg nitrates, neg leukocytes, negative glucose, 3+
protein. She thinks that maybe she had some vaginal spotting several days ago, but nothing since.
Pt relates that she has had some constipation, and increased gas for past several months. She was using NFP for contraception prior to her stopping her period. No other urinary symptoms reported.
Update:
· Limited physical exam shows well developed, well-nourished obese Hispanic female in no apparent distress.
· Breasts: pendulous, bilateral white/yellow nipple discharge noted
· Abd: obese, ? mass in Abd but difficult to assess due to body habitus, otherwise soft and non-tender. Fungal dermatitis under pannus.
· CVA: No cva tenderness.
· VVBSU: WNL, some watery d/c noted, nitrazine positive. Vagina with pink with rugae present. Good pelvic support, no cystocele or rectocele noted.
· Cervix: soft, smooth without CMT, os parous, slightly open
· Uterus: difficult to assess due to body habitus however feels enlarged by bi manual exam.
· Adnexa: not palpated
Question 1: What testing are you considering?
Question 2. What is your differential diagnosis?
Question 3. What is your differential diagnosis?
US demonstrates single live intrauterine pregnancy at 38 weeks gestation in the vertex presentation. EFW 5'2". Amniotic fluid appears subjectively decreased. Juanita as admitted to the local hospital and diagnosed with premature rupture of the membranes and subsequently went on to deliver a healthy male infant 4 hours later.