Good Afternoon. I have been lurking around this site for awhile now and decided to join. I wanted to spark some debate with a case presentation. My residency director and I have differing views and I was wondering if I am completely off base (and need to shut up!).
Here is what I saw in our community hospital clinic about a week and a half ago:
21 yo female with chief complaint of lethargy (which she relates is secondary to having a menstrual cycle every 2 weeks for the past 2 months and every 3 weeks for the 2 mos prior to that). She also admits to feeling "scatter-brained" and her feet and hands have weird sensations (couldn't get anything more specific out of her on this). And notes an increase in left breast over the past few months (this is noticeable upon physical exam). Denies any PMH, PSH, and drug abuse; currently not on any medication.
So, I thought to draw TSH, FSH, LH, Prolactin, estrogen, progesterone, testosterone, CBC and chem 7. My director said to draw TSH, FSH, LH and prolactin and get an abdominal ultrasound. Labs have come back normal (TSH is 2.8). Waiting on ultrasound. My main concern is, I think a CBC and chem 7 are a good idea as well as a T4 level (I have been told to wait for the ultrasound results). I was also thinking we should do an ultrasound while on her cycle and not on her cycle???
Any constructive criticism would be appreciated (especially if I am not on the right track).
Here is what I saw in our community hospital clinic about a week and a half ago:
21 yo female with chief complaint of lethargy (which she relates is secondary to having a menstrual cycle every 2 weeks for the past 2 months and every 3 weeks for the 2 mos prior to that). She also admits to feeling "scatter-brained" and her feet and hands have weird sensations (couldn't get anything more specific out of her on this). And notes an increase in left breast over the past few months (this is noticeable upon physical exam). Denies any PMH, PSH, and drug abuse; currently not on any medication.
So, I thought to draw TSH, FSH, LH, Prolactin, estrogen, progesterone, testosterone, CBC and chem 7. My director said to draw TSH, FSH, LH and prolactin and get an abdominal ultrasound. Labs have come back normal (TSH is 2.8). Waiting on ultrasound. My main concern is, I think a CBC and chem 7 are a good idea as well as a T4 level (I have been told to wait for the ultrasound results). I was also thinking we should do an ultrasound while on her cycle and not on her cycle???
Any constructive criticism would be appreciated (especially if I am not on the right track).
