Case Studies

How should patients whose Pap smear results show inflammation and no other abnormalities be managed?

Three separate case studies assess different problematic prenatal presentations: unexpected bleeding during the second trimester; unexplained rash development in the third trimester; and pain in the groin combined with numbness in one leg.

As a part of his employer’s incentive pay program, Mr. B came in for a routine physical. He was a seemingly healthy 37-year-old white man with no medical complaints to report. Mr. B worked as a correctional officer and, as such, was encouraged to keep his health records current. His annual exam was supposed to be pro forma, but it revealed silent traits that even he was astonished to find.

Ms. H, a 36-year-old G0 arrives at the clinic for a focus visit complaining of heavy menstrual bleeding. Her periods are “regular,” occurring monthly, but have become increasingly heavy. She complains that she now “soaks through” her sanitary protection and often passes clots.

Mrs. A, a 32-year-old G2, P2 arrives at the office for a focus visit complaining of right lower quadrant pain for two days that is increasing in intensity.

Mrs. D, a 36-year-old G0, comes in for a fertility evaluation. She and her husband have been attempting to conceive with regular unprotected intercourse for six months with no pregnancy. Mrs. D is uncertain about whether their timing is appropriate for conception.

Miss R, a 22-year-old G0 patient comes in for a focus visit. She is complaining of vaginal burning and discharge that has lasted for one week. She has tried over-the-counter (OTC) yeast infection medication but “nothing has helped.”

Although Miss A doesn’t need a pap test, based on her age (18), sexual history, and recommendations by the CDC, she provides a urine sample that is sent for chlamydia and gonorrhea testing. Miss A’s urine test comes back positive for gonorrhea.

Miss C, a nulliparous 23-year-old woman, arrives as a new patient for an annual exam. She is also requesting information about contraceptive options. She states that she’s concerned that she would not be “a good pill taker” on a daily basis. Her periods are regular, not painful, and light. Miss C states that she does not want children for a “long time,” if ever.

Mrs. G is well groomed and communicative. She is married and works full time as a clerical assistant in a dental office. Mrs. G considers herself to be healthy. She is “determined to quit” smoking. She reported one “abnormal pap” five years ago that “cleared up” on follow-up pap tests. Mrs. G complains that her periods, while regular, are becoming very heavy and painful.