Ms. Bell is a 28-year-old female who presents with lower abdominal pain for two
Ms. Bell is a 28-year-old female who presents with lower abdominal pain for two weeks: achy pelvic pain worsened by activity and sexual intercourse. She reports associated nausea, vomiting, and alternating loose stools and constipation. Her last menstrual period was four weeks ago; she is sexually active without birth control and has many psychosocial stressors and reports her husband drinks alcohol and frequently and sometimes use physical violence. Physical examination is notable for lower abdominal tenderness, numerous ecchymoses across her abdomen and extremities, a small amount of yellowish, malodorous vaginal discharge, and no cervical motion tenderness. The ideal summary statement concisely highlights the most pertinent features without omitting any significant points. The summary statement above includes: Epidemiology and risk factors: 28-year-old female, LMP four weeks ago, sexually active without birth control Key clinical findings about the present illness using qualifying adjectives and transformative language: Achy lower abdominal and pelvic pain worsened by activity and sexual intercourse Alternating loose stools and constipation Many psychosocial stressors Reports her husband drinks alcohol frequently but she rarely drinks Lower abdominal tenderness Numerous ecchymoses across her abdomen and extremities Absence of cervical motion tenderness Small amount of yellowish, malodorous vaginal discharge Answer the following questions using the latest evidenced based guidelines: 1• Discuss the questions that would be important to include when interviewing a patient with this issue. 2• Describe the clinical findings that may be present in a patient with this issue. 3• Are there any diagnostic studies that should be ordered on this patient? Why? 4• List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each. 4• Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.

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