Problem
Tina is a married 25-year-old female who presents for her annual physical exam. She is G1P0 with a history of SAB at 7 weeks EGA one year ago. Her LMP was 2 weeks ago and she reports regular 3-day menses every cycle. She and her husband have used coitus interruptus as their primary method of birth control during the first two years of the marriage, but now they do not use any form of birth control because they would like to start a family. Tina's last Pap was 3 years ago and WNL. She denies any significant medical history or health problems. She drinks 2-3 glasses of wine most evenings with dinner and smokes tobacco cigarettes "recreationally" which she describes as "mostly on weekends when she is with her friends." She denies any illicit drug use and does not take any medications. Her pregnancy test is negative and her vital signs are all WNL.
A. What will you perform and order during this visit, and why?
B. What medical, social, and habits history and patient education are important during this visit?
C. Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnoses, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.