Marjorie

Case study - Marjorie

Marjorie presents at your clinic this morning without an appointment. Earlier this morning she had "terrible pain-down on the right side and felt faint". She is sitting in the waiting room with her sister and although the pain has eased off somewhat, she says she still feels really uncomfortable. You see from her notes that Marjorie is 34, has been generally well and her last visit with you was for contraception -she is using the progestogen only pill. You note that she has also mentioned getting discomfort on and off in her lower abdomen at previous visits but this pain was much worse.

Have a look at the following questions and jot down your answers. When you have finished check these with what we think.

a) What is the first test that you will do today and why?

b) Here is the USS report that you ordered-what is your advice to Marjorie now.

Now click here to have a look and see if what you have written agrees with our answers

Marjorie is now begining to feel a lot more comfortable. The first test you would do would be a pregnancy test to rule out ectopic. This is negative. The scan shows that Marjorie has had a rupture of a functional ovarian cyst and the fluid released can be very irritating, hence her pain. Women who use the progestogen only pill may be more likely to get functional cysts and she would do better with a contraceptive method that suppresses ovarian activity such as the combined pill or depo provera.

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