Dialogue Particulars ADVANCED PATHOPHYSIOLOGY
Hematopoietic: J.D. is a 37 years old white girl who presents to her gynecologist complaining of a 2-month historical past of intermenstrual bleeding, menorrhagia, elevated urinary frequency, gentle incontinence, excessive fatigue, and weak point. Her menstrual interval happens each 28 days and recently there have been 6 days of heavy movement and cramping. She denies stomach distension, back-ache, and constipation. She has not had her typical vitality ranges since earlier than her final being pregnant.
Previous Medical Historical past (PM H): Upon reviewing her previous medical historical past, the gynecologist notes that her affected person is a G5P5with 4 pregnancies inside 4 years, the final toddler having been delivered vaginally 4 months in the past. All 5 pregnancies have been unremarkable and with out supply issues. All infants have been born wholesome. Affected person historical past additionally reveals a Three-year historical past of osteoarthritis within the left knee, most likely the results of sustaining vital trauma to her knee in an MVA when she was 9 years old. When requested what OTC drugs she is at present taking for her ache and for the way lengthy she has been taking them, she reveals that she began taking ibuprofen, three tablets every day, about 2.5 years in the past for her left knee. As a result of a slowly progressive enhance in ache and a lack of satisfactory reduction with three tablets, she doubled the each day dose of ibuprofen. Upon the advice from her nurse practitioner and since long-term ibuprofen use could cause peptic ulcers, she started taking OTC omeprazole on a common foundation to forestall gastrointestinal bleeding. Affected person historical past additionally reveals a Three-year historical past of HTN for which she is now being handled with a diuretic and a centrally performing antihypertensive drug. She has had no earlier surgical procedures.
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