History of Present Illness (HPI): Cindy is a 25-year-old Hispanic G1P0010 who presents to the office for annual gynecologic exam. Her LMP was 1 week ago, and she does not use contraception. The patient has no current complaints and denies abnormal uterine bleeding. She has never had cervical cancer screening and is unsure if she received the HPV vaccine. She reports 3 sexual partners in the last 6 months.

Prior medical history: Chlamydia. Prior surgical history: None

Current medications: None. Allergies: None

GYN History: Menarche age 13, cycle length- 7 days- frequency every 28 days- 4-5 tampons per day.

Positive history of chlamydia 1 year ago. Never had cervical cancer screening.

LMP: 1 week ago. Contraception history: None, does not use condoms.

Social history: Lives with a roommate. Works as a bartender. ETOH 3-4 vodka drinks 2 nights/week.

Denies recreational drug use, never smoker.

Family history: Unremarkable.

Review of Systems (ROS): Negative.

Physical Exam (PE)

VS: BP: 110/70, P: 90, RR: 18, T: 98.4, Weight: 122 lbs, Height 5’6”., BMI 19.7

External: Appropriate hair distribution, No lesions, Small, painless lump palpated at left vaginal opening.

Mild swelling noted. Speculum exam: Scant yellow vaginal discharge, no lesions, no cervical motion

tenderness (CMT). Bimanual exam: uterus normal size firm and non-tender. No adnexal masses palpated

bilaterally, nontender. Breast exam normal. Her physical exam is otherwise unremarkable.

Case #2. Maxine.

History of Present Illness (HPI): Maxine, a 31-year-old G0, is an established patient of your practice and

presents today for a routine well woman exam. She was married 4 months ago after a short courtship

with a family friend. She denies any complaints, however, you notice she is more withdrawn that usual

and is not making eye contact with you. When asked about her menstrual cycle, she states her menses

have been irregular over the past 3 months, skipping one month and bleeding twice the next month.

Last period was 2 weeks ago and was a very heavy flow that, causing her to change tampons every hour

on the first 2 days. She is not using any contraception because her husband wants a child right away.

Prior medical history: None. Prior surgical history: None

Current medications: Prenatal vitamins. Allergies: Penicillin

GYN History: Menarche age 10, normal cycle length of 5 days, until recently. Now with irregular cycles

and heavy flow. No history of sexually transmitted infections (STIs). No history of pregnancy. Last cervical

cancer screening was 3 years ago and normal. Performs regular SBE at home.

LMP: 2 weeks ago. Contraception history: None.

Social history: Lives with her new husband. Housewife – husband made her quit her job after they were

married. Admits to 1 – 2 glasses of wine during the day when husband is working. Nonsmoker.

Family history: Mother and father alive and well. MGM alive– breast cancer age 65

Review of Systems (ROS): Unremarkable except for menstrual cycle changes.

Physical Exam (PE)

VS: BP: 109/66, P: 87, RR: 16, T: 97.3, Weight 101 lbs (visit last year was 122 lbs), Height 64”, BMI 17.3

General: Withdrawn, does not make eye contact. Oriented x 3. Appears slightly disheveled and

underweight.

Integumentary: Warm, dry, and intact. Bruise noted to right inner thigh.

Abdomen: Soft, NTND, BS present x 4.

External: Appropriate hair distribution, No lesions or erythema. Speculum exam: No discharge, no

lesions, no cervical motion tenderness (CMT). Bimanual exam: uterus normal size firm and non-tender.

No adnexal masses palpated bilaterally, nontender. Breast exam normal.

Case #3. Lucy.

History of Present Illness (HPI): Lucy, a 64-year-old G3P3003 postmenopausal woman, presents to the

office as a new patient to establish care and for an annual well woman exam after recently moving to the

area. She does not have her records. She relates a history of regular and negative cervical cancer

screening until she had her first cotest 2 years ago indicating HPV positive, cytology negative results. She

c/o vaginal dryness and dyspareunia. She has never been on hormone replacement therapy but would

consider something to alleviate her symptoms.

Prior medical history: Dyslipidemia, Osteopenia, Hypothyroidism, Uterine fibroids

Prior surgical history: Hysterectomy – ovaries and cervix retained (2009)

Current medications: rosuvastatin 10mg daily, levothyroxine 75mcg daily, Vitamin D3 (k2) 5,000 IU daily

Allergies: Sulfa, Codeine

OB- GYN History: NSVD x 3 (1980, 1983, 1989) healthy female 6lb 8oz; healthy female 7lbs 6oz; healthy

male 6lb 6oz. Menarche age 13, normal periods. No history of sexually transmitted infections (STDs).

LMP: Hysterectomy 2009. Contraception history: Never used.

Social history: Lives alone. Recently moved to the area after her husband of 45 years passed away. Plays

pickle ball 3 times/week. Healthy diet. Never smoked. ETOH – 1 glass wine/ nightly.

Family history: Mother deceased (age 62)- breast cancer. Father deceased (age 70)- CVA, leukemia.

Review of Systems (ROS): Unremarkable with exception of as noted in HPI.

Physical Exam (PE)

VS: BP: 130/78, P: 78, RR: 18, T: 98.1 Weight: 152 lbs., Height: 67”, BMI 23.8

General: Awake, Alert, Oriented x 3. Well developed, well nourished. Pleasant.

Integumentary: Warm, dry, and intact. No lesions, rashes, or bruises.

Abdomen: Soft, NTND, BS present x 4. Surgical scar noted.

External: Grey sparse hair distribution, atrophic changes noted. Speculum exam: No discharge, no

lesions, multiparous cervix. Bimanual exam: uterus surgically absent, No adnexal masses palpated

bilaterally, nontender. Breast exam – left breast with walnut size mass palpated at 9 o’clock position.

Nontender. Right breast normal exam. No nipple discharge.

Case #4. Nadine.

History of Present Illness (HPI): Nadine is a 22-year-old female G0 who presents for a well woman exam.

She is interested in starting birth control. She is sexually active with her boyfriend; they do not use

condoms.

Prior medical history: Sickle cell trait, Systemic lupus erythematosus (SLE), Pulmonary embolism,

Dysmenorrhea. Prior surgical history: None

Current medications: Plaquenil, Cellcept, prednisone, lisinopril, Eliquis, atorvastatin, omeprazole.

Allergies: None

OB- GYN History: Menarche age 12, cycle length-5 days- frequency every 28 days- 3 tampons per day.

History of chlamydia in the past year. Has received Human Papillomavirus (HPV) vaccine series.

LMP: 3 weeks ago. Contraception history: Withdrawal

Social history: Lives with her sister. Denies EtOH or recreational drug use. Vapes daily. Does not

exercise. Poor diet – fast food and sodas.

Family history: Mother alive – sickle cell. Father alive – HTN.

Review of Systems (ROS): Unremarkable.

Physical Exam (PE)

VS: BP: 133/68, P: 87, RR: 18, T: 98.2 Weight: 188 lbs., Height 64”, BMI 32.3

Lab – urine pregnancy test negative

General: Obesity in female. Oriented x 3. Pleasant.

Integumentary: Warm, dry, and intact.

Abdomen: Soft, NTND, BS present x 4.

External: Appropriate hair distribution, No lesions or erythema. Speculum exam: No discharge, no

lesions, no cervical motion tenderness (CMT). Bimanual exam: uterus normal size firm and non-tender.

No adnexal masses palpated bilaterally, nontender. Breast exam normal.

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