CLIPP # 22 – Pelvic Inflammatory Disease (Mandy)

This case is for a 16 year old female, Mandy, who presents to the doctor with
abdominal pain. She claims the pain has been there for a few days and it is in the
right upper quadrant region of the abdomen. She is sexually active and uses
condoms sometimes and instead uses a spermicidal preparation. The diagnosis of
appendicitis comes to mind but it is excluded after palpation at McBurneys point
elicited no pain. She did have a purulent discharge from her cervix along with
cervical motion tenderness. I am thinking of pelvic inflammatory disease since
Chandelier sign is almost always associated with PID. This case provides a very good
review of PID and also of scenarios dealing with ethical and legal associations.
Mandy came with her mother but did not want her to be involved in her sexual
history and that is up to her discretion. Also, this case provides a very good
understanding of reporting sexually transmitted diseases and procedures where a
sexual partner also should be treated and how to involve everyone in the dialogue to
make sure patient’s health is of most importance and at the same time, autonomy
and confidentiality is also respected. One important thing I learned from this case,
which can be very useful, is the PQRST AAA acronym for pain and it stands for
position, quality, radiation, severity, timing, alleviating factors, aggravating factors,
and associated symptoms. Overall an informative review of pelvic procedures,
history taking for adolescents and diagnostic methods to rule out similar conditions.

FM # 1 – Annual Exam (Mrs. Payne)

This case is about Mrs. Payne, who is a 45-year-old female and she is at the doctor’s
office for an annual exam. This is her first exam in over 5 years. She is overweight,
does not exercise, and smokes. She received information to address her weight and
she lost 10 pounds since her last visit. She was also informed on ways to quit
smoking and now she is down to 1-2 cigarettes per day. This case clarified a lot of
milestones such as peri-menopause and menopause and what should be done
during each time. I learned the procedures on how to perform a breast exam. I have
not been able to do it in the clinic but it did clarify certain things such as in which
direction to apply pressure. The procedure explained in the case for a speculum
exam differs from the way I learned it in the clinic. We do not use any other material
(no lubrication or warm water) before inserting the speculum and we use a cotton
swab before we gather any samples to clear any discharge from the external cervical
os. Overall a good review of many exams that may be done in absence of pathology.