O:   Best-corrected visual acuity is 20/400 in the right and…

O:   Best-corrected visual acuity is 20/400 in the right and 20/80 in the left. Refraction in the office does not make much improvement in her vision.  There is no afferent pupillary defect.  Motility is full bilaterally.  External examination reveals deep sockets bilaterally.  She has some upper lid dermatochalasis, OU.  On slit-lamp examination, corneas are clear bilaterally.  Anterior chambers are quiet and deep.  Irises both reveal surgical iridectomies.  She had posterior chamber lens implants in both eyes.  Her left pupil is bound down to her lens implant.  Dilated fundus examination reveals diffuse peripapillary atrophy bilaterally, as well as significant retinal pigment epithelial clumping and atrophy to bilateral maculae.   This patient shows indications of a previous surgical procedure on her eye.  What type of procedure was performed?

CC:         Patient reports delusions of persecution.  A sus…

CC:         Patient reports delusions of persecution.  A suspicious demeanor and other signs of paranoid process have been observed.  Sleep has been difficult.  Patient reports tremors and rigidity of muscles in neck and shoulders and worries about Parkinson’s disease.  Demands an MRI for detection.   Q.  The patient demands a test that may detect Parkinson’s disease.  Describe the test she demands.

CC:  “a very bad smelling discharge from my vagina” x3w S: …

CC:  “a very bad smelling discharge from my vagina” x3w S:  29 y/o f, gravida 1, para 2 HPI:  Hx 3w bad smelling discharge from vagina; thick, white; seems heavier in mornings. Social Hx:  lives c boyfriend + 1 child in home, not working, denies exposure to smoke and denies smoking.  Reports 1 regular sex partner and 7 lifetime partners.  Experiences painful intercourse and severe cramping during menstruation.  States sometimes uses condoms, but knows the importance of them. Med hx:  + for 1 c-section delivery of twins, dx of Chlamydia in 2012, 2006, 2008, and dx of Gonorrhea in 2007. Pregnancy hx:  twins at 21 weeks via C-section due to complications with pregnancy Menstrual hx:  LMP “two weeks ago” c “heavy but normal flow” x5-7d, no bleeding/spotting since then, last PAP unknown, no mammogram O:  PELVIC:  ext. genitalia and vaginal walls pink, cervix intact, thick white foul spelling discharge noted in vaginal canal, lower pelvic tenderness noted on bimanual exam, uterus smooth and within normal limits, ovaries not palpable LABS:  Gonorrhea and Chlamydia culture—results pending A:  Dx:  Bacterial vaginosis P:  MEDICATION:  antibiotic 500mg bid for 1 week   What is the patient’s OB history?