Family Medicine: Aquifer 32
Using the attached Aquifer Case Study, answer the following questions using the latest evidenced based guidelines:
• Discuss the questions that would be important to include when interviewing a patient with this issue.
• Describe the clinical findings that may be present in a patient with this issue.
• Are there any diagnostic studies that should be ordered on this patient? Why?
• List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.
• Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.
Complete 2 page
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Describe the risk factors for dysmenorrhea. Describe normal and abnormal physical examination findings on a pelvic exam. Discuss an appropriate differential diagnosis for a patient with dysmenorrhea. Describe the treatment of dysmenorrhea. Define menorrhagia. Discuss the Assessment of a patient with possible premenstrual syndrome (PMS). List the treatment options for a patient with premenstrual syndrome. Describe the use and insertion for the progestin only intrauterine device (IUD) in a patient with dysmenorrhea.
Knowledge
Primary Dysmenorrhea Definition, Prevalence, and Risk Factors
Primary dysmenorrhea is defined as the onset of painful menses without pelvic pathology. Secondary dysmenorrhea is defined as painful menses secondary to some additional pathology. Primary dysmenorrhea is associated with increasing amounts of prostaglandins. The actual prevalence is unknown but ranges from 20% to 90%. Ten to fifteen percent of assigned females feel their symptoms are severe and have to miss school or work. Dysmenorrhea usually occurs hours to a day prior to the onset of menses and lasts up to 72 hours. Risk Factors for Primary Dysmenorrhea
Mood disorders such as depression or anxiety have been associated with dysmenorrhea, especially in adolescents. This may be a complex association as other factors may be comorbid with the mood disorder diagnosis, and the cause and effect is not well proven. However, there is an association with stress independently as a risk factor for dysmenorrhea. There is also an association between tobacco use and dysmenorrhea. Females who have more children are noted to have a decreased incidence of primary dysmenorrhea. Additionally, females who report overall lower state of health or other social stressors have a tendency for dysmenorrhea. These stressors include social, emotional, psychological, financial, or family stressors. Primary dysmenorrhea most commonly occurs in females in their teens and twenties. It is notably associated with ovulatory cycles. Classically, an adolescent will start experiencing dysmenorrhea one or two years after menarche. This is the time it takes naturally for an adolescent to develop regular ovulatory cycles. The earlier the onset of menarche the more likely dysmenorrhea may occur.
This means that a detailed history regarding the nature of menses during adolescence and after children is important. It will also be important to ask about birth control and what types have been used as some can alter the symptoms. The first-line treatment for primary dysmenorrhea is nonsteroidal anti-inflammatory agents, such as ibuprofen. Oral contraceptive pills may also be helpful as a second-line choice.
Gender
People who are born with a uterus may identify as female or male. We can therefore identify this population as “female assigned at birth,” meaning they had a sex assigned at birth as female based on the genitalia seen, or “person with a uterus” to acknowledge the biologic presence of a uterus in someone who may identify as anything other than female in their life. See below for additional gender Teaching Points.
Gender and Sexual Identity Questions
It is important to know how your patient self-identifies, and to not make assumptions. To avoid mis-gendering patients, we recommend asking early in a visit either how they would like to be addressed and/or what pronouns they use. Common answers are he/him, she/her, and they/them, but countless other pronouns exist within the LGBTQ community (lesbian, gay, bisexual, transgender, queer/questioning; this also includes a broad range of sexual, romantic, and gender minorities, and is more inclusively referred to as LGBTQIA with intersex and asexual/ally also represented). Cisgender refers to a person whose sex assigned at birth, based on genitalia, matches their current gender identity. Family Medicine: Aquifer 32
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Aquifer 32
Answer the following questions using the attached Aquifer Case Study:
• Brainstorm questions to ask a patient with this situation.
• Should this patient have any diagnostic tests? Why?
• Identify the patient’s primary and secondary diagnoses. Justify your choices.
Explain your treatment approach for this patient, including pharmacologic therapy, tests and patient education.
2 page finish
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Identify the causes of dysmenorrhea. Describe typical and abnormal pelvic exam findings. Discuss a patient’s dysmenorrhea differential diagnosis. Describe dysmenorrhea treatment. Menorrhagia Examine a patient with potential PMS (PMS). Describe the therapy options for PMS. Describe the use and insertion of a progestin-only IUD in a dysmenorrhea patient.
Knowledge
Primary Dysmenorrhea: Causes and Risk Factors
Painful menses without pelvic disease are called primary dysmenorrhea. Secondary dysmenorrhea is painful menses caused by another disease. Prostaglandins are linked to primary dysmenorrhea. The prevalence is unclear but ranges from 20% to 90%. 10%-15% of assigned females suffer severe problems and miss school or work. Dysmenorrhea occurs hours to a day before menses and can persist up to 72 hours. Prevalence of Dysmenorrhea
Depression and anxiety have been linked to dysmenorrhea, particularly in teens. Other causes may be comorbid with the mood disorder diagnosis, and the source and effect is unknown. However, stress has been linked to dysmenorrhea. Tobacco smoking is linked to dysmenorrhea. Primary dysmenorrhea is less common in women who have more children. Females with poor overall health or other social stressors are more prone to dysmenorrhea. There are many different types of stressors. Primary dysmenorrhea affects mostly females in their twenties. It is linked to ovulatory cycles. Dysmenorrhea typically begins one or two years following menarche. This is how long an adolescent takes to achieve normal ovulatory cycles. The earlier menarche occurs, the more likely dysmenorrhea is.
This means a detailed history of menses during adolescence and after childbirth is critical. Ask about birth control and what types were taken, as some can affect symptoms. Primary dysmenorrhea is treated with nonsteroidal anti-inflammatory drugs like ibuprofen. Oral contraceptive tablets are a good backup option.
Gender
Those born with a uterus can be feminine or male. This demographic can be classified as “female assigned at birth” (based on genitalia) or “person with a uterus” (based on the biological presence of a uterus in someone who does not identify as female). See more Gender Teaching Points below.
Gender and Sexuality Issues
It’s critical not to make assumptions about your patient’s identity. A patient’s preferred method of address and/or pronoun usage should be discussed early in a visit to minimize misgendering. The most common pronouns are he/him, she/her, and they/them, however the LGBTQ community (lesbian, gay, bisexual, transgender, queer/questioning) has innumerable others. Cisgender is someone whose genital sex assigned at birth matches their present gender identity. Aquifer 32
