MEDICAL ENGLISH 2

PAPER CASE 50

By:
Athaya Hafizhah 13310048
Dea Nabila 13310076
Fathimah Azzahra 13310129
Zahrotul Jannah 13310447
 CASE
A 28 year old woman nulliparous woman present for evaluation of irregular
menstrual cycles for the past year. Her periods will come only every 2 or 3
months and she has gone as long as 4 month without a period. Currently, she
give last menstrual period of 11 weeks ago. She says she has menarche at age
13 years and that her cycle have been mostly regullar, usually occurring
every 30 days, but she would miss one here and there. She has never been on
hormonal contraception. She doesnt smoke, doesnt drink alchohol and
doesnt exercise. She is sexually active with a single partner and use condom
for contraception. On review of system, she reports a 30-ib weight gain in the
past 18 months, but otherwise has felt fine. On examination, she is noted to be
obese, with a body mass index of 30. Her vitals signs are otherwise normal. She
has fine hair grow on her face and velvety thickening of the skin on her neck.
On her general physical examination is normal. A pelvic examination reveals
normal external genitalia, no vaginal or cervical discharge, no cervical motion
tenderness, and no uterin or adneksal masses.

KEYWORDS
1. 28 years old nulliparous woman
2. Irregular menstrual cycle for past year
3. Her periods will come only every 2 or 3 months
4. 4 month without a period
5. Menarche at age 13 years, that her cycle have been mostly regullar
6. Never been on hormonal contraception
7. Doesnt smoke, doesnt drink alchohol and doesnt exercise
8. Sexually active with a single partner and use condom for contraception
9. Obese, with a body mass index of 30
10.No vaginal or cervical discharge, no cervical motion tenderness, and no
uterin or adneksal masses

PROBLEM
A 28 year old woman nulliparous woman present for evaluation of irregular
menstrual cycles for the past year. Her periods will come only every 2 or 3
months and she has gone as long as 4 month without a period.
DIFFERENTIAL DIAGNOSIS
1. Irregular menstrual cycle
Is a changes in the normal menstrual cycle: a period which occurs later
or earlier than whatever is normal.
Also means that the interval between periods varies each month. That is,
sometimes they come every 2 month, sometimes every 3, sometimes
every 4.

The most common causes of irregular periods are:

- Eating disorders, like anorexia and bullimia
- Excessive weight gain or weight loss; extreme thinness and obesity
both cause your menstrual cycle to become irregular or even to
disappear
- Stress or emotional problem
- Hormonal problems for example is when the thyroid malfunctions
- Tumor

2. Pregnancy
The period from conception to birth. After the age is fertilized by a
sperm and then implanted in the lining of the uterus, it develope into
the placenta and the embryo and later into a fetus (baby).
Pregnancy lasts 40 weeks.
INVESTIGATION
1. USG
USG is to look inside the utery that we can see through the monitor.
This investigation is important, because we can make sure about the
condition of utery and masses, baby, or anything else inside the utery.

1) First of all, i want you to lift up your clothes till your stomach seen
2) Now im just going to wash the area a bit of antiseptic
3) Then, i will spreading some gel ultrasonic on your stomach
4) Okay, now were ready to look inside your utery with the usg stuff
5) We can look through the monitor
2. Urine test
This investigation is using test pack to check the hCG levels that confirm
the pregnancy or cyst that shows with 2 red strips.
The patient should be given an urin test because we need to know that
her problem causes by pregnancy or cyst.

1) First of all, I will give you the place of urine and test pack
2) I want you to do this on bathroom, first you have to fill it
with your urine sufficiently. Then you can plunge the test
pack into urine.
3) Wait a few minutes and now were ready to see the result,
two strip or one.

3. Levels of progesteron and estrogen

Progesteron and estrogen are hormons thats have a role play of the
maturation of ovum through the pregnancy or menstruation.
The patient could be given this test, because in this case the patient has
irregular menstrual cycle and she has gone as long as 4 month without a
period. So we can see the involvement of both hormones are stabil or
not. But, this test is fairly expensive.
4. Full blood count
Hb : to confirm anemia
Leucocyte : increase = she has a bacterial infection
Decrease = viral infection

1) Before I take your blood, im going to wash the area with a bit of
antiseptic.
2) Now, I will take some blood of your arm, properly on fossa cubiti.
3) And then i will bring your blood to the laboratory to be examined.
4) Wait the result.

5. Cholesterol levels
To see how severely elevated cholesterol, because it can induce
hormonal imbalance that can impact the menstrual cycle.

The patient could be given this test to make sure the relation between
her obese with her problem.

The procedure is the same as full blood count test.