Overview
Case #2. Joanna.
History of Present Illness (HPI): Joanna is a 28-year-old Caucasian G4P1021. She is single, living with her father and 2-year-old daughter. She has a part-time job as a server at the local restaurant; she does not have health insurance. Joanna presents to your office at the community health center today stating she is pregnant and wants to receive OB care. She tells you that she has not yet been evaluated for this pregnancy as she was afraid to take time off from work and did not have enough money to pay for the visit. Prior medical history: None. Prior surgical history: None Current medications: None. Allergies: Penicillin OB- GYN History: NSVD (2021) healthy female 6lb 8oz. Menarche age 10, cycle length- 3 days- irregular cycles since menarche- frequency every 20-30 days- 2-3 tampons per day. No history of sexually transmitted infections (STDs). Joanna’s OB history includes two first trimester elective terminations of pregnancy, and 1 term female infant delivered vaginally at 37 weeks. Denies any complications during her prior pregnancy however, she notes that her daughter experienced hypoglycemia and respiratory distress, spending 2 weeks in the Neonatal Intensive Care Unit (NICU). LMP: Approximately 5 months ago. Contraception history: Condoms “sometimes”. Social history: Lives with her retired father and daughter. Restaurant server. Denies EtOH or recreational drug use. Currently smoking 1 pack of cigarettes/ day (15 pack-year history). She and her mother are still paying for her daughter’s NICU stay. The child’s father is not involved in any way. Family history: Mother (deceased age 55)- Type 2 diabetes. Review of Systems (ROS): Unremarkable with exception of dysuria (“it burns when I pee”) over the past 1-week. Denies fever, chills, abdominal or flank pain. Thick white vaginal discharge and “itching” for the past month. Physical Exam (PE) VS: BP: 108/68, P: 72, RR: 18, T: 37.3, Weight 144lbs On physical exam you palpate a fundal height of approximately 20cm with an audible fetal heart tone (FHT) of 160. On speculum exam you visualize a multiparous cervix without lesions; bluish discoloration of the cervix, vagina, and vulva is noted with a thick, white discharge. There is no cervical motion tenderness (CMT) on exam. The uterus is anteverted, non- tender, with fundus palpable at the umbilicus. Joanna’s physical exam is otherwise unremarkable.
Wet mount reveals budding yeast. Urine dipstick with 1+ leukocytes, trace blood and 2+ glucose