For my first history and physical, I presented on a case that stuck with me for the rest of the week. A 26 year-old female with no significant GYN history presented with vaginal discharge, chronic pelvic pain, right slightly worse than left, and bilateral nipple discharge, again right slightly worse than left for two weeks. On exam her pain was significantly exacerbated by the bimannual examination that I performed and a rapid response was activated for concern about ruptured ovarian cyst. She was sent to the emergency room, where she was found to have no free fluid in the abdomen and no acute findings, with her presentation contributed to likely inflammatory pelvic disease. When presenting my case to my preceptor I made two sets of differential diagnosis, one for pelvic pain and another for nipple discharge. I included the various vaginitises (BV, yeast, gonorrhea/chlamydia, trichomonas) under the the differential diagnosis for pelvic pain. My preceptor gave me feedback saying that I should have a third differential diagnosis list for vaginal discharge, and not to lump it together with pelvic pain. My thought process was that a vaginitis could lead to pelvic inflammatory disease, but I now understand that each problem needs it own differential diagnosis and that I should not lump them together.

For my second history and physical I decided to chose an OB case since I selected a GYN case for my first history and physical. That patient was a 31 y/o female G1P0 at 37w1d pregnant early onset of fetal growth restriction presenting with likely rupture of membranes approximately 8 hours prior to delivery, at which time she was found to be 2cm dilated. She was also complaining of decreased fetal movement for the past three days. I decided to select this case because I was interested in coming up with a differential diagnosis for the decreased fetal movement and because I wanted to think critically about an OB case.