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Assessment 1 HISTORY: Describe the history you just obtained from this patient.

Include only information (pertinent positives and negatives) relevant to this patients problem(s). HPI: 54 YO F COMES FOR A MENOPAUSE DRUG REFILL. ONSET OF MENOPAUSE WAS 1 YEAR AGO. PREMARIN USE STARTED 1 YEAR AGO, COMPLIANT WITH MEDICATION. PREMARIN, 0.3 MG BY MOUTH 1 TIME A DAY FOR 1 YEAR.SHE STOPPED TAKING 6 WEEKS AGO. PATIENT REPORTS HOT FLASHES, NIGHT SWEATS, AND VAGINAL DRYNESS SINCE STOPPING MEDICATION. PATIENT REPORTS PAIN WITH SEX ALLEVIATED WITH LUBRICATION. PATIENT DENIES JOINT PAIN, BOWEL OR BLADDER CHANGES, DIAAINESS FATIGUE OR CHEST PAIN. 2 CHILDREN 2 PREGNANCIES, LMP 2 YEARS AGO NORMAL, LPS 1 YEAR AGO NORMAL, MENARCHE AGE 13 ROS: FRACTURED RIGHT ARM ALLERGIES: NONE MEDICATIONS: PREMARIN 0.3 MG PO ONE DAILY FOR 1 YEAR PMH: NONE PSH: NONE FH: PARENTS ALIVE AND WELL SH: DENIES TOBACCO, ETOH, OR GRUG USE. LIVES WITH HUSBAND, WORKS AS A LAWYER, SEXUALLY ACTIVE WITH HUSBAND ONLY. PHYSICAL EXAM: Describe any positive and negative findings relevant to this patients problem(s). Be careful to include only those parts of examination you performed in this encounter. THE PATIENT IS IN NO ACUTE DISTRESS AND VITALS ARE WITHIN NORMAL LIMITS. THE HEAD, NECK, EYES AND THROAT APPEAR NORMOCEPHALIC AND ATRAUMATIC. HIS BREATH SOUNDS ARE CLEAR TO AUSCULTATION. HIS HEART SOUNDS ARE NORMAL S1/S2. HIS ABDOMEN HAS BOWEL SOUNDS PRESENT WITH NO TENDERNESS AND NO DISTENSION. THERE WAS NO GUARDING. THERE WAS NO BRUISING OR EDEMA PRESENT ON THE EXTREMITIES. DATA INTERPRETATION: Based on what you have learned from the history and physical examination, list up to 3 diagnoses that might explain this patients complaint(s). List your diagnoses from most to least likely. For some cases. Fewer than 3 diagnoses will be appropriate. Then, enter the positive or negative findings from the history and physical examination (if present) that support each diagnosis. Lastly, list initial diagnostic studies (if any) you would order for each listed diagnosis (e.g. restricted physical exam maneuvers, laboratory tests, imaging, ECG, etc.

Diagnosis #1: Menopausal symptoms HISTORY FINDING(S) -HOT FLUSHES -NIGHT SWEATS -VAGINAL DRYNESS Diagnosis #2: Osteoporosis HISTORY FINDING(S) -RIGHT ARM FRACTURE -HOT FLASHES -ON PREMARIN MEDICATION FOR THE LAST 1 YEAR Diagnosis #3: Atrophic vaginitis HISTORY FINDING(S) -VAGINAL DRYNESS -HOT FLASHES -NIGHT SWEATS

PHYSICAL EXAM FINDING(S) -PATIENT IN NO ACUTE DISTRESS -BREATH SOUNDS CLEAR -BOWEL SOUNDS HEARD

PHYSICAL EXAM FINDING(S) -PATIENT IS IN NO ACUTE DISTRESS -BREATH SOUNDS CLEAR -BOWEL SOUNDS HEARD

PHYSICAL EXAM FINDING(S) -PATIENT IS IN NO ACUTE DISTRESS -BREATH SOUNDS ARE CLEAR -BOWEL SOUNDS HEARD

Diagnostic studies: -Pelvic exam -Dexa bone scan -CBC -UA-XR-Right arm