A 32-year-old African American woman presents to the clinic for her 24-week check-up. Pt states
her morning sickness has resolved. However, she states she seems sad often and does not
understand why, as she is happy about the pregnancy.
HPI: Pt is 24 weeks gestation. The patient is having sad moods at least once a day. She also states
she is tired all the time, but figures that is just part of being pregnant, but has no energy and does
not feel like doing her usual daily chores. She finds it difficult to go to work every day. This
moodiness started about a week ago. She tried going to bed earlier but it did not seem to help.
Taking 1 prenatal vitamin every day, No known drug, food, or environmental allergies. Family
history is significant only for diet-controlled DM in paternal grandfather with onset in mid 40’s,
Mother 58 yrs old is healthy; Father 60 yrs old with hx of DM with onset at age 45 and chronic
depression which began in early 20s.
Objective Info
Height 5’4” Wt 147 lbs; BMI 25.2; 132/78 (sitting); HR-88/min
• General: Appears well nourished, hair is in disarray, with flat affect
• HEENT: Normocephalic, no lumps/lesions
• Neck: supple without adenopathy , no thyromegaly.
• Lungs: Eupneic, CTA-bilaterally
• CV: RRR, soft systolic murmur Grade II/VI, no rubs noted; 2+ peripheral pulses, no
edema noted
• Breast: Soft, enlarged, fibrocystic changes bilaterally noted without masses, dimpling or
discharge, no redness or inflammation noted. Breast self-exam reviewed
• GU: Uterus at umbilicus- approximately 24 wks size and non-tender. FHT present with
Doppler
Questions
1. What other information do you need?
2. What diagnostic would be appropriate for this pt?
3. What are the risk factors for this patient?
4. What other screenings are appropriate for this patient?
5. What management treatment would be most effective for this patient?
6. What are the possible maternal and newborn complications with this health problem?
