1Week 4 Case StudyCase Study: Missed PeriodJuanita Morales is a 47-year-old G5. P5 LC 6, Hispanic female who presents to the officecomplaining of lower abdominal cramping, and urinary leakage for past day. She states theabdominal cramping, suprapubic, started several hours ago, is sharp, intermittent, and gettingmore frequent and painful. She tried Motrin but states it did not help. She had a UTI years agoand it was like this, except the incontinence. She has been more tired for the past severalmonths. She relates she stopped getting her period about 8-12 months ago, and relates hermenopause was easy. She relates no medical or surgical history. She has no known drugallergies and takes no medications. Social history is negative for alcohol, tobacco, andrecreational drugs. Her last exam was several years ago.Vital signs: temperature 99.1, BP 140/ 82, pulse 88, respirations 12. Height is 5′ andweight 235 lbs. (BMI 45.89). A clean catch urine was obtained, and the urine dipstickshowed SG 1.010, trace blood, neg nitrates, neg leukocytes, negative glucose, 3+protein. She thinks that maybe she had some vaginal spotting several days ago, but nothingsince.Pt relates that she has had some constipation, and increased gas for past several months. She wasusing NFP for contraception prior to her stopping her period. No other urinarysymptoms reported.Update:Limited physical exam shows well developed, well-nourished obese Hispanicfemale in no apparent distress.Breasts:pendulous, bilateral white/yellow nipple discharge notedAbd: obese, ? mass in Abd but difficult to assess due to body habitus,otherwise soft and non-tender. Fungal dermatitis under pannus.CVA:No cva tenderness.VVBSU:WNL, some watery d/c noted, nitrazine positive. Vagina with pinkwith rugae present. Good pelvic support, no cystocele or rectocele noted.Cervix:soft, smooth without CMT, os parous, slightly openUterus:difficult to assess due to body habitus however feels enlarged by bimanual exam.Adnexa:not palpatedWeek 4 case study- Missed PeriodQUESTIONS 1 :What testing are you considering?The testing to consider in this case are as follows: