Step 2 CS Blue sheet Case Dyspareunia

These are the blue sheet, physical exam, diagnostic studies and differential diagnosis needed for a Dyspareunia case in the USMLE Step 2 CS exam (which will be similar to amenorrhea with some slight differences):

BLUE SHEET Dyspareunia:

“As with all pain cases, use ALICIA, LIQOR_AAA or the one that suits you the most”.

MNEMONIC Dyspareunia (Very similar to Menstrual irregularities/amenorrhea):

“FLAG HI V”: When missing a period that’s a “FLAG” that we will say “HI” to a new “Visitor” at home. + VAD.

F: Fat pill (to lose wt use).

L: Libido status

A: Anorexia (eating behaviors)

G: Galactorrhea

H: Hot flashes

I: Insomnia

V: Visual changes

——

V: Vaginal discharge and symptoms like itching, secretions.

A: Abuse (always suspect abuse in the Step 2 CS, mostly in women, children and elderly patients), in this case, could be the cause of the problem. Use SAFEGARDS mnemonic.

D: Douching

PHYSICAL EXAMINATION

1. Lungs:

Auscultation

2. Heart:

Auscultation

3. Abdomen

Inspection

Auscultation

Palpation

Percussion

POSSIBLE DIAGNOSTIC STUDIES:

Pelvic and breast examinations. Do not forget this!.
Wet mount, KOH preparation.
Cervical cultures.
FSH-LH.
U/S pelvis.
Laparoscopy as needed (last resort in endometriosis, usually will be too much for be done initially).

DIFFERENTIAL DIAGNOSIS:

Divide them into 2 groups: Pre-menopausal and post-menopausal:

PREMENOPAUSAL:

Endometriosis.
Infections: Cervicitis, vaginitis, pelvic inflammatory disease.
Domestic violence.
Vulvodynia.
Vaginismus (Spasms with penetration).
Depression.
Premature ovarian failure.

POSTMENOPAUSAL:

Vaginal atrophy.
Lichen sclerosus.
Pelvic tumors.

I hope this information was helpful for you, please leave your comments below and I will try to answer as soon as possible. Start practicing early the mnemonics for easier memorization. Good luck with your studies.