OGBYN Shannon MacDonald

OGBYN Shannon MacDonald

CC – Inability to get pregnant Diagnosis – Hyperprolactinemia, endometriosis, uterine fibroids, hyperthyroidism (grave’s). Tests- obstetric ultrasound, thyroid function tests, prolactin 6as/3pmh/1fh/1ros hx67/ex95/ddx50/ddxr100/mnm75/test50/dx100/ex71 Problem Statement: ( Demographic description – chief complaint – Hx and PE key findings – risk factors ) Shannon is a 27 y/o thin, athletic female, G0P0 with complaint of infertility despite having regular intercourse for 2 years. Her husband’ssemen analysis is normal. Shannon has a longstanding history of menstrual irregularity and runs several miles daily. PE shows a thyroid twice the normal size with bruit and thrill that moves with swallowing, PE also shows fine resting tremors in her hands as well as hair thinning that is localized to the outer 1/3 of her eyebrows. Shannon had surgery for appendectomy at age 17, is a former smoker, and has never had an STI or PID. CC: Shannon is a 27 y/o thin, athletic female, G0P0 with complaint of infertility despite having regular intercourse for 2 years. Her husband’s semen analysis is normal. HPI: Shannon has a longstanding history of menstrual irregularity and runsseveral miles daily. Meds: none. PMH: Patient is a former smoker, but denies drinking, and recreational drug use. She’s had surgery for appendectomy at age 17. ROS: Only positive findings are seen in HPI Physical Exam: VS: Pulse – 92; BP – 120/70, RR – 18; T – 99.3F (37 C); SpO2 – 98% Skin: latter 1/3 of eyebrowsshows extremely thin hair, Nails show onycholysis, Neck: Thyroid twice normal size (45 gm), bruit heard over thyroid, thrill can be palpated – thyroid moves with swallowing Extremities: Extended hand exam is positive for fine resting tremors.