Uploaded by Ruben Juarez

Module 10 HW notes

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Module 10
Symptom
Amenorrhe
a
Breast
Complaints
DDx
Primary
- Pregnancy
- Turner
Syndrome
- Constitutional
Delay
Secondary
- Polycystic
Ovarian
Syndrome
- Premature
ovarian failure
- Stress
- Infiltrative
lesions or
tumors
- Fibrocystic
disease
- Fibroadenoma
- Mastitis/Breas
t Abscess
- Breast Cancer
Alarm Symptoms
- Recent unprotected
intercourse(pregnanc
y)
- Headaches, loss of
peripheral
vision(pituitary)
- Body weight 15%
below idea and
impaired body
image(Anorexia)
- Dizziness
-
-
Pelvic Pain
Acute PP
- Ectopic
Pregnancy (P)
- Abortion (P)
- Acute PID(OB)
- Ovarian cyst
(OB)
- Appendicitis(G
I)
- IBS (GI)
- UTI (GU)
- Renal calculus
(GU)
-
-
Breast Mass
Skin ulceration,
thickening
Axillary mass
Bloody nipple
discharge
Family hx of
breast/ovarian
cancer
Headaches, bone
pain respiratory
symptoms
Pain <15 Days
Sexual Contact with
known gonorrhea
carrier
Fever/Chills
ABD Bleeding
Most Common
- Pregnancy
- Ovarian disease
once
pregnancy
ruled out
“Most common
complaints”
- Breast lumps
- Nipple
discharge
- Breast pain
Classification:
- Pregnancyrelated causes
- Gynecologic
disorders
- Nonreproducti
ve disorders:
(GI & GU)
Chronic PP
- Endometriosis
- Primary
dysmenorrhea
- Adnexal
Torsion
-
Vaginitis
-
Abnormal
Vaginal
Bleeding
-
-
UTI
Foreign Body
Bacterial
Vaginosis
Trichomoniasis
Cervicitis
Physiologic
Discharge
PID
-
Endometrial
Cancer
Ectopic
pregnancy
Hemorrhage
Ovarian
Cancer
Normal
intrauterine
pregnancy
Spontaneous
abortion
Coagulopathy
-
-
-
Confusion, lethargy
Fetid, feculent
discharge
Dys/hema-turia
Bleeding
Fever
Dizziness
Vaginal Sores
-
90% infectious
-candidiasis, trichomoniasis,
-bacterial
vaginosis
Dizziness, lightheadedness,
abdominal pain and
known pregnancy
Weight Loss
Increased abdominal
girth (bloating)
-
Depends on
reproductive
status of
patient
DocCom: 18 “Asking about sexuality”
- Reasons for taking sexual history
o ID pt at risk for STD/HIV/AIDS
o ID sexual dysfunction
o Changes in sexual function due to medication side effects
- Kathleen Murphy - Pt wearing colored ascot, with black shirt
o Feeling depressed
o Diagnosed with genital herpes 16 years ago, hasn’t had intercourse with anyone
else since then
o Didn’t want to warn people about herself
-
-
o Would like to feel not ashamed
Ashley – teen
o Wearing black sweater, blue shirt
o Sexually active with her bf
Doctor wearing brown sports blazer
Four motifs of boundary violation b/w clinician and patient
o 1) a reversal of roles (the patient takes care of the doctor)
o 2) a secret (shared intimate feelings)
o 3) a double bind (it is impossible to stay in or get out of the relationship)
o 4) an indulgence in professional privilege (the doctor prevails upon the
patient to meet a personal need).
-
Seductive video on flirting
o Medical student is wearing pink shirt
o Patient: wearing black turtle neck
Doccom 28 “Domestic Violence” “intimate partner violence” = IVP
Quick Stats said in video
- 30-50% of women experience domestic violence
- Doctor wearing blue shirt with white polkadots
Why is patient coming in? “miss doman”
- Wearing red shirt
- “headaches”, can’t get work done at home. Taking time away from schedule. Husband is
going to be upset, trying to do a better job as a wife
- Common sign for IPV is headaches
Key things to ask about when suspecting
- Ask about thoughts and feelings, and any plans
- Ask about safety
- Ask about child abuse
- Ask about mood
- Ask about substance abuse
What are important things to say once patient discloses violence? (4)
- This is wrong
- Its not your fault
- You are not alone
- Lets talk about some choices.
Documenting
- Take pictures of injuries, draw maps, and stages of healing.
- Write who committed the injury and with what instrument
- Describe the facts; do not write “patient alleges or patient alleges”
Lone bear story
- She left husband three years ago