Case Study 1: Alterations of the Reproductive Function
Ms. P.C. is a 19-year-old white female who reports a 2-day history of lower abdominal pain, nausea, emesis and a heavy, malodorous vaginal discharge. She states that she is single, heterosexual, and that she has been sexually active with only one partner for the past eight months. She has no previous history of genitourinary infections or sexually transmitted diseases. She denies IV drug use. Her LMP ended three days ago. Her last intercourse (vaginal) was eight days ago and she states that they did not use a condom. She admits to unprotected sex “every once in a while.” She noted an abnormal vaginal discharge yesterday and she describes it as “thick, greenish-yellow in color, and very smelly.” She denies both oral and rectal intercourse. She does not know if her partner has had a recent genitourinary tract infection, “because he has been away on business for five days.
Microscopic Examination of Vaginal Discharge
(-) yeast or hyphae
(-) flagellated microbes
(+) white blood cells
(+) gram-negative intracellular diplococci
Case Study Questions
1. Can a diagnosis of PID be made based on the clinical manifestations of the illness at this point? Why or why not?
2. Which type of infection is suggested by microscopic examination of the vaginal discharge and other laboratory tests: chlamydial, gonococcal, or mixed chlamydial/gonococcal?
3. Should this patient be hospitalized and promptly given IV antibiotics? Why or why not?
Case Study 2: Alterations of the Integumentary Function
K.B. is a 40-year-old white female with a 5-year history of psoriasis. She has scheduled an appointment with her dermatologist due to another relapse of psoriasis. This is her third flare-up since a definitive diagnosis was made. This outbreak of plaque psoriasis is generalized and involves large regions on the arms, legs, elbows, knees, abdomen, scalp, and groin. K.B. was diagnosed with limited plaque-type psoriasis at age 35 and initially responded well to topical treatment with high-potency corticosteroids. She has been in remission for 18 months. Until now, lesions have been confined to small regions on the elbows and lower legs.
Case Study Questions
1. What has possibly triggered this patient’s current outbreak of psoriasis?
2. Why should a topical medication not be considered an option for this patient?
3. What is the preferred treatment for this patient?
4. Why is it important that the primary care provider know that the only medications that K.B. has been taking are ibuprofen and Rolaids?
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