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Diversity in Medicine: Addressing the Disparities in Healthcare. African-American Women’s Medicine. Case I. Ms. Jones is a 31y.o. G2P2 LMP 01/01/2010 States she feels well but “a bit anxious” and overwhelmed at work New onset vague lower back pain

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diversity in medicine addressing the disparities in healthcare

Diversity in Medicine:Addressing the Disparities in Healthcare

African-American Women’s Medicine

case i
Case I
  • Ms. Jones is a 31y.o. G2P2 LMP 01/01/2010
  • States she feels well but “a bit anxious” and overwhelmed at work
  • New onset vague lower back pain
  • Decreased appetite, decreased interest in sex
  • Frequent insomnia, fatigue
  • Last felt well one year ago after the birth of her son.
physical exam case i
Physical Exam Case I
  • Ht. 60in Wt. 101lbs Bp 100/70 R 18 T 98.7

Physical examination: unremarkable

All labs within normal limits including TSH and autoimmune profile

past history case i
Past HistoryCase I
  • Past Obstetrical History: two sons ages 1 and 2 uncomplicated vaginal deliveries
  • Past Surgical History: none
  • Past Family History: Mother “nervous breakdown” after her divorce at age 32
  • Brother: Bi-polar type 2
  • Past social History: Works as executive bank home loan officer at Wells Fargo
case i discussion
Case IDiscussion:
  • Awareness: What do you see? What do you hear? What are your thoughts as a clinician?
  • Any stereotypes?
  • What’s your plan?
  • Let’s discuss this case in detail
case ii
Case II
  • Ms. Williams is a 35y.o. G0P0 LMP 3mo ago presents with complaints of intermittent vaginal discharge and itching.
  • Recently has unexplained weight loss, increased thirst, increased urinary frequency.
  • Denies pelvic pain, N/V/F/C
  • Trying to conceive for the past 2 years
case ii physical examination
Case IIPhysical Examination
  • Ht. 62 inches Weight 180lbs BMI>30
  • Bp 142/98 Temperature 98.6
  • Heart: mild murmur
  • Lungs: clear to auscultation
  • Abdomen: no masses palpated/ obese
  • Ext: mild edema pedal
  • Pelvic Exam: consistent with discharge likely yeast
case ii past history
Case IIPast History
  • Past Medical history: has not been to the doctor in 5 years
  • Past Family History: Sister age 13 with type II DM, Mother with type II DM, HTN
case ii labs
Case IILabs
  • HgA1c: 9
  • FBS: 120
  • 2hour OGTT: 205
  • Genital Cx: Consistent with Candida Albicans
case ii discussion
Case IIDiscussion
  • What are your thoughts?
  • What is your diagnosis? Is there more than one?
  • Let’s discuss this in detail
case iii
Case III

Tanisha is a 21 y.o. G2P0 LMP 01/10/2010 presents to the ER with a 3 day complaint of pelvic pain progressively worsening in the past 24 hours.

  • The pain is associated with nausea no vomiting, moderate vaginal bleeding and foul smelling discharge.
  • Further history includes new boyfriend for the past two weeks, no use of condoms
case iii physical exam and past medical history
Case IIIPhysical Exam and Past medical History
  • Ht. 67in weight 128lbs Bp 110/70 R 18 T. 100.4 Pulse 110
  • Past Surgical History: D & C x two
  • Past Ob History: elective ab x 2
  • Meds: orthotricyclen-lo
  • Abdomen: extremely tender
  • Pelvic Exam: foul smelling discharge, cervical motion tenderness, chandelier sign
case iii discussion
Case IIIDiscussion
  • What is your diagnosis?
  • What are you thinking?
  • Let’s discuss the social issues
case iv
Case IV
  • Mrs. Smith is a 60 y.o. G5 P5 LMP 9 years ago who presents with c/o vaginal dryness and painful sexual intercourse. Recent onset of recurrent headaches rated 8/10.
  • Denies N/V/F/C
  • Exercises intermittently works as head publicist for the William Morris Agency manages a “superstar”
case iv physical examination
Case IVPhysical Examination
  • Ht. 68inches Weight 140lbs BP 160/110
  • R 18 Temperature 98.6
  • Past Medical hx: Menopause 9years ago
  • Past Surgical Hx: neg
  • Past Family Hx: Mother died breast CA age 51, Sister with HTN, Brother ESRD with transplant last year @ age 40
  • All: NKDA
  • Past Social Hx: No ETOH,Drugs, eats fast food everyday, loves IN N Out Burgers
case iv discussion
Case IVDiscussion
  • What are you concerned about as a clinician? What are you thinking and why?
  • Let’s discuss this case in detail.

What have we learned from these cases..

Has this presentation changed your perspective ? How will you approach the AA patient now with common medical complaints.