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  #1  
Old 08-11-2013
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Default How is my PN?

Hi, I was hoping to get some feedback on my PN. Thanks. This is FA case #23


HISTORY: 36 yo F c/o amenorrhea for 3 months. She was regular previously with 4-5 days of bleeding but now her cycles are every 6-7 weeks with 7 days of bleeding. Her age of menarche was 14 years. She used to use 2-3 pads a day but her menstrual flow is less and uses only one pad. She is also plucking her facial hair. She has also noticed a milky discharge from her breast. She denies vaginal spotting, no vaginal itchiness, no cold intolerance, no hot flashes.
PMH: non-contributory
Allergies: NKDA
Meds: OCP for 8yrs
FH: Father and Mother healthy
SH: works as a nurse, vegetarian for 10 yrs, runs 2-3 miles a week, no tobacco, no etoh, no drugs, sexually active with husband twice a week
PE:
Pt in no acute distress
VS: WNL
CV: RRR, normal S1/S2
Lungs: Clear to auscultation bilaterally
Abd: BS +, no hepatosplenomegaly
Extrem: no edema
Neuro: DTRs intact
DIAGNOSIS #1: Pregnancy
History Findings: LMP 3 months ago, weight gain, milky discharge
PE Findings:
DIAGNOSIS #2: PCOS
History Findings: LMP 3 months ago, facial hair plucking, weight gain
PE Findings:
DIAGNOSIS #3: Hypothyroidism
History Findings: weight gain, menstrual irregularities
PE Findings:
DIAGNOSTIC WORKUP: pregnancy test, TSH, pelvic exam, US of pelvis

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  #2  
Old 08-12-2013
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Diagnostic tests:
Pelvic exam
Urine HCG
TSH
FSH/LH levels
Testosterone levels
Serum glucose
Lipid profile
US pelvis
(list the forbidden first)
(this is too complete lol but urs is good
For PCOS u can just say menstrual irregularities. No need for LMP 3 weeks ago. U did that for pregnancy though so its fine.
For HPI just say she has started to become oligomenorrheic and
is experiencing hypomenorrhea (instead of saying periods every 6-7 weeks and now uses less pads) u can include these details
in the OBGYN part under the HPI ie LMP was 2 weeks ago. Menarche began at age X. Periods are regular occurring every X weeks and last X days with X flow. GXPX. Uncomplicated pregnancy at full term X yrs ago. Last pap smear was 6 months ago; no history of abnormal pap smears. Sexually active with husband; uses OCPs for contraception or whatever.
so basically HPI should be concise. But what u did is not wrong at all
u forgot to mention thyroid normal in Neck part for physical exam.
i would also put thyroid disease instead of hypothyroidism since both hyper and hypo
can cause amenorrhea. So u can add HEENT: EOMI with no diplopia or lid lag or lid retraction
Neck: No goitre
Extremities: No tremor (or edema).
and may be even include skin.
its v good imo.

Last edited by add1; 08-12-2013 at 04:20 AM.
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ifss (08-12-2013)
  #3  
Old 08-12-2013
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but i can see why u said hypothyroidism
because of weight gain.
Then just add neck: No goitre in the physical exam
section
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  #4  
Old 08-12-2013
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Thanks for that great feedback
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