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BackgroundDecision Point OneWhat is your differential diagnosis? What is your treatment plan?

Gloria Smart is a 75-year-old female who presents to your office today for regular gyn care. You read her medical history and note she received a cardiac stent at age 55, has mild hypertension, and is on Zocor, Plavix, and lisinopril. Surgical history is remarkable for tonsils as a child and bunion surgery. She works full time, by choice, because it "makes me feel young." She is up to date with colonoscopies. Gyn history normal pap history, last DXA within normal limits, normal mammogram. BMI is 26. First menses age 14 and menopause age 54. She works out at her local gym 5 days a week. Social history is negative for tobacco and recreational drugs. She has an occasional glass of wine. She has never married and has been with her current partner for 2 years and will be getting married in 2 months. She has never been pregnant, and her partner has never had a child.

Gloria relates as you start to talk to her that she and her fiancé have been talking about it, and they would like to have a child. She read an article about a woman in Canada who was 80 and about another one in India who was 78. She wants a referral and some guidance

  • Why did you make this diagnosis decision?
  • What evidence-based research can you provide to support your decision (choice for differential diagnosis and plan/intervention)?
  • What resources did you use to meet your best practice guidelines?

make sure to provide evidence using the literature to support your discussion and point-of-view.


provide details regarding the case (e.g., surrogacy; pregnancy, contraception, etc.)


Address the ethical dilemmas and/or other issues for your case study:

  • Ethical issues
  • Psychological issues
  • Physical issues
  • Financial issues
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Background Gloria Smart is a 75-year-old female who presents to your office today for regular gyn care. You read her medical history and note she...
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