PBL 6 session 2

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PBL 6 session 2 by Mind Map: PBL 6 session 2

1. Step 6

1.1. Review session 1

1.2. Report new knowledge

1.2.1. Physiology sperm production ovum production conception

1.2.2. Common fertility dysfunction in males and females Male factors female factors both idiopathic

1.3. 30 minutes

1.4. The scribe doesn't have to write in this step

2. Step 8

2.1. Diagnostic decision

2.1.1. Wife PCOS

2.1.2. Husband abnormal sperms

2.2. Mechanism

2.2.1. Wife High FSH, low LH

2.2.2. Husband pests exposure smoking alcohol

2.3. Presentation

2.3.1. Wife irregular cycle acne

2.3.2. Husband varicocele

2.4. Supporting data

2.4.1. Wife cysts in ovaries laparascopy pelvic inflammatory disease

2.4.2. Husband sperm specimen taken with abnormal results

2.5. 10 minutes

3. Step 7

3.1. Inquiry plan and info gathering

3.1.1. History of presenting complaint

3.1.2. Previous medical / surgical history husband arrived from italy since 8 no history of infections or sexual experience worked in farm growing fruit trees with many chemicals including pesticides and fruit collection had no sexual education before feels pressure by his parents to have a child wife wife had irregular periods since age of 13 took pills to regularize her peroid put on IUCD on 20 years no contraception used since age 20

3.1.3. Drug history / allergy

3.1.4. Family history

3.1.5. Social / occupational history husband frequent drinker smokes two packs a day wife was married at 24 she did not tell Raj about her previous pregnancy now she is having very heavy periods and irregularity with big clots having intercourse 3 times a week without discomfort but Raj seemed less keen she was worried about her weight gain and facial hair

3.1.6. Systemic review

3.1.7. Physical examination Husband healthy male obese 98 KG with normal secondary sexual characters testicular volume is 18 ml both sides vas present on both sides chance of varicocele on left testis rectal examination: normal prostate wife obese 89 kg slight facial hair associated with her Mediterranean background mild acne vaginal examination

3.1.8. tests results husband could not masturbate 1.1 ml volume 15% normal morphology 5.4 million sperm/ml 50% motility previous sexual experience with a prostitute wife pap smear - neg vaginal US laparoscopy free androgens 19.2

3.2. 50 minutes