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Cyberschool Creators: Kevin Baumlin, MD and michael Bessete, MD
Module Author: Ed Mintz, MD
Web Authors: Judah Fierstein and Marcy Wang
| V.D., a 20 y.o. female presents to the emergency department complaining of a yellow vaginal discharge for two days. She denies fever or chills but does complain of mild suprapubic cramping and pain also of two days duration. Her last menstrual period is 20 days prior to presentation. The patient is sexually active with two routine sexual partners, one of whom is an intravenous drug user. One of her sexual partners had a penile discharge two weeks ago for which he was treated with "a shot." |
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1. |
What additional elements of the HPI and PMH would you like to know? What are some of the risk factors for sexually transmitted diseases among women? |
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2. |
Discuss the key elements of a directed physical exam in this patient? |
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3. |
What tests would you send? | |||
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4. |
The ER tech informs you that he/she cannot find any Thayer-Martin agar. Can you substitute chocolate agar? |
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5. |
On your pelvic exam you notice a yellow discharge emanating from the cervical os. The abdomen is soft and you are unable to appreciate any cervical motion tenderness or adnexal masses. How would you treat this patient? If she were pregnant, how would your treatment change? |
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6. |
Same initial presentation except that the patient is noted to have a fever of 38.2 C and slight cervical motion tenderness on your exam. A WBC of 12,400 with 84% neutrophils is noted. How would these finding alter your management? |
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7. |
The patient has shallow tender ulcerations on her labia. What is your diagnosis? How should this be treated? | |||
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8. |
The lesions shown in the accompanying slide are seen in the patient's mouth. What is your diagnosis? How should this be treated? |
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