1-7 PATIENT NOTE: PAIN DURING SEX HISTORY: Describe the history you just obtained from this

patient. Include only information (pertinent positives and negatives) relevant to this patients problem(s). HPI: 30 YO FEMALE C/O PAIN DURING SEX. STARTED A FEW WEEKS AGO, BURNING, POUNDING PAIN DURING INTERCOURSE WITH PERIUMBILICAL ABDOMINAL PAIN. NO POST COITAL BLEED. RECENT THICK, WHITE VAGINAL DISCHARGE WITH A FISH ODOUR AND VAGINAL ITCHING. LMP 2 WEEKS AGO NORMAL, REGULAR EACH MONTH. LASTS FIVE DAYS USES 4 PADS PER DAY. SEVERE MENSTRUAL CRAMPS EACH MONTH, NO SPOTTING. LPS 1 YEAR AGO AND NORMAL. NO CHILDREN, NO PREGNANCIES. LIBIDO IS GOOD. ROS: NEGATIVE EXCEPT AS NOTED ABOVE ALLERGIES:SEASONAL MEDICATIONS: NONE PMH: GONORRHEA 7 YEARS AGO, TREATED WITH ANTIBIOTIC, NO RECURRENCES PSH: NONE FH: PARENTS LIVE AND WELL SH: DENIES TOBACCO, ETOH OR DRUGS, WORKS AS A SOCIAL WORKER, HAS ONE BOYFRIEND FOR 2 YEARS DOES NOT USE CONDOMS. 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. PHYSICAL EXAMINATION: GA: PATIENT IS IN NO ACUTE DISTRESS VS: WNL CHEST: CLEAR BREATH SOUNDS BILATERALLY HEART: RRR, NORMAL S1/S2, NO RUBS, GALLOPS, MURMURS ABDOMEN: SOFT, NONTENDER, NONDISTENDED, BS+ 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: PELVIC INFLAMMATORY DISEASE HISTORY FINDING(S) - burning pain during intercourse - thick white vaginal discharge with PHYSICAL EXAM FINDING(S) - periumbilical abdominal pain - abdomen non distended

Fish odour - h/o gonorrhea 7 years ago DIAGNOSIS #2: CERVICITIS HISTORY FINDING(S) - thick white vaginal discharge with a fish Odour - vaginal itching - h/o gonorrhea 7 years ago DIAGNOSIS #3: ENDOMETRIOSIS HISTORY FINDING(S) - pain during intercourse - periumbilical abdominal pain - cramps during menstruation each month DIAGNOSTIC STUDIES: - PELVIC EXAM - WET MOUNT/KOH PREP - U/S PELVIS - MRI-PELVIS - CBC/UA

- bowel sounds present

PHYSICAL EXAM FINDING(S) - periumbilical abdominal pain - abdomen non distended - bowel sounds present

PHYSICAL EXAM FINDING(S) - periumbilical abdominal pain - abdomen non distended - bowel sounds present