The Quizzes about Vaginal Bleeding (24 test)

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1.A 23-year-old woman presents to the emergency department (ED) with irregular menstrual bleeding. She denies any abdominal pain, dizziness, or The patient reports that her last menstrual period (LMP) was 2 weeks ago with normal flow and duration. Which of the fol- lowing ancillary tests is critical in defining the differential diagnosis for this patient?

1. Type and screen.
2. Coagulation panel.
3. b-Human chorionic gonadotropin (b-hCG).k
4. Complete blood count (CBC).
5. No ancillary tests are needed.

2. A 30-year-old G2P2 with a history of Chlamydia presents to the ED with acute onset of severe lower abdominal pain associated with vaginal bleeding that began 2 hours before She denies any prior medical history but does report having a tubal ligation after the birth of her second child. Her vitals are significant for a heart rate (HR) of 120 beats per minute and a blood pressure (BP) of 90/60 mm Hg. On physical examination, her cervical os is closed and she has right adnexal tenderness with blood in the posterior vaginal vault. Given this patient’s history and physical examina- tion, which of the following diagnoses do you most strongly suspect?

1. Heterotopic  pregnancy
2. Pelvic inflammatory disease (PID)
3. Placenta previa
4. Ectopic pregnancy
5. Abruptio placentae

 3. A 28-year-old G1P0 at 36 weeks presents with the sudden onset of severe abdominal pain with distention and vaginal bleeding. She denies contractions. Her vitals are significant for an HR of 120 beats per minute and a BP of 156/80 mm Upon further history, the patient reports the pain developed immediately after recent cocaine use. Which of the follow- ing conditions are you concerned about because of which you call a stat OB-GYN?

1. Uterine rupture
2. Acute cocaine intoxication
3. Placenta accreta
4. Vasa previa
5. Ruptured ovarian cyst

4. A 24-year-old G2P0010 in her second trimester presents to the ED with vaginal spotting for the past She denies any abdominal pain and is otherwise in her usual state of health. Her vital signs are HR of 76 beats per minute, BP of 120/65 mm Hg, respiratory rate of 16 breaths per minute, and temperature 98.9°F. Which of the following conditions is the most likely cause of this patient’s symptoms?

1. Ectopic pregnancy
2. Placenta previa
3. Abruptio placentae
4. Uterine rupture
5. Ovarian torsion

5. A 24-year-old G3P1112 presents to the ED with vaginal bleeding and Her vital signs include an HR of 110 beats per minute, BP of 130/70 mm Hg, and RR of 14 breaths per minute with an oxygen satura- tion of 99% on room air. She is afebrile and in mild distress. Recent medical history is significant for vaginal delivery 2 days ago with prolonged labor. Pelvic examination is significant for a large, boggy uterus, and a normal vaginal wall. What is the most likely diagnosis in this patient?

1. Genital tract trauma
2. Endometritis
3. Uterine atony
4. Ectopic pregnancy
5. Uterine artery rupture

6. A 40-year-old G1P0101 presents to the ED with suprapubic pain and general malaise for the last 3 days without Her vitals are significant for HR of 115 beats per minute, BP of 100/60 mm Hg, and temperature of 101°F. Upon physical examination, her abdomen is soft with significant suprapubic tenderness to light palpation but no rebound or guarding. Her pelvic examination reveals a scant amount of dark red vaginal blood and yellow discharge. Her past medical history is significant for an emergent cesarean section 2 weeks ago without any other gyneco- logic history. What is the most likely diagnosis in this patient?

1. Uterine atony
2. Retained products of conception
3. Uterine inversion
4. Endometritis
5. Tubo-ovarian torsion

7. A 17-year-old girl presents to the ED with worsening nausea and vom- She reports her LMP was 9 weeks ago and has had some “morning sickness” over the past several weeks. However, for the past week her nau- sea and vomiting has been so severe that she is unable to tolerate more than a few sips of water or juice. Her vitals include HR of 96 beats per minute, BP of 190/100 mm Hg, and temperature of 99°F. Her physical examination is significant for a fundal height at the umbilicus. After obtaining a positive b-hCG, sonographic evaluation reveals the following image. What is the most likely underlying condition for this patient’s symptoms?

1.  Ectopic pregnancy
2. Hydatidiform mole
3. Ovarian torsion
4. Abruptio placentae
5. Hyperemesis gravidarum

8. A 25-year-old G1P0 presents to the ED with vaginal She recently discovered that she was pregnant and has yet to be medically eval- uated. She does not know her LMP. Before presentation, the patient was in her usual state of good health with no history of trauma or any other symp- toms. She reports using two absorbent pads an hour for the bleeding and does not notice passing fetal tissue. On physical examination, her cervical os is open. Which of the following is the most appropriate diagnosis?

1. Threatened abortion
2. Complete abortion
3. Inevitable abortion
4. Incomplete abortion
5. Missed abortion

9. A 36-year-old G4P2103 presents to the ED with vaginal spotting for the past 2 She also reports occasional abdominal cramping and low back pain. The patient states that she is 4 months pregnant. She denies any other past medical history or gynecologic problems. Her initial vital signs include HR of 89 beats per minute, BP of 144/70 mm Hg, and RR of 15 breaths per minute with oxygen saturation of 98% on room air. Her pelvic examination reveals a closed os. Upon ultrasound examination, an intrauterine pregnancy is visualized; however, a fetal HR (FHR) is not detected. Given this patient’s symptoms and physical examination, which of the following is the most appropriate diagnosis?

1. Threatened abortion
2. Complete abortion
3. Inevitable abortion
4. Incomplete abortion
5. Missed abortion

10. A 33-year-old G3P2002 presents to the ED complaining of vaginal bleeding that started earlier in the She has gone through two pads over the last 12 hours. She describes mild lower abdominal pain. Her BP is 105/75 mm Hg, HR is 78 beats per minute, temperature is 98.9°F, and RR is 14 breaths per minute. Pelvic examination reveals clotted blood in the vaginal vault with a closed cervical os. Transvaginal ultrasound documents an intrauterine pregnancy. Which of the following is the correct diagnosis?

1. Threatened abortion
2. Complete abortion
3. Inevitable abortion
4. Incomplete abortion
5. Missed abortion

11. A 21-year-old G4P1001 presents to the ED because she was unable to find the outpatient She states that she was recently diagnosed with a miscarriage and was told to follow up today for repeat blood work. She denies vaginal bleeding, abdominal cramping, and has no other com- plaints. Her BP is 115/70 mm Hg, HR is 68 beats per minute, temperature is 98.6°F, and RR is 15 breaths per minute. Pelvic examination is normal with a closed cervical os. b-hCG is 125 mIU/mL and old records reveal her blood type to be B+. Which of the following is the correct diagnosis?

1. Threatened abortion
2. Complete abortion
3. Inevitable abortion
4. Incomplete abortion
5. Missed abortion

12. A 19-year-old G2P1001 presents to the ED with complaints of severe lower abdominal cramping and vaginal bleeding with the passage of several large She states that she is approximately 10 weeks by LMP but has not followed up with her OB-GYN yet this pregnancy. She denies trauma or injury and has no other complaints. Her BP is 98/50 mm Hg, HR is 88 beats per minute, temperature is 98.6°F, and RR is 18 breaths per minute. Pelvic examination reveals several large clots in the vaginal vault with what appears to be mucinous material emerging from the external os. The inter- nal os is 1 cm on bimanual examination. b-hCG is 100,850 mIU/mL and transabdominal ultrasound reveals an intrauterine pregnancy with an esti- mated gestational age of 9w5d by crown-rump length (CRL) and an FHR of

Her blood type is O+. Which of the following is the correct diagnosis?

1. Threatened abortion
2. Complete abortion
3. Inevitable abortion
4. Incomplete abortion
5. Missed abortion

13. A 28-year-old woman presents to the ED with heavy menstrual flow for the last 2 days with She reports using about two pads every hour. The patient states that she has occasional metromenorrhagia in the past and has been treated with oral contraceptives. She reports symptoms of feeling lightheaded but denies any syncope, palpitations, chest pain, abdominal pain, or weakness. Her initial vital signs include HR of 96 beats per minute, BP of 135/70 mm Hg, and RR of 14 breaths per minute with oxygen satura- tion of 99% on room air. Upon physical examination, the patient is obese and you note a pronounced hairline. Which of the following conditions is most consistent with this patient’s presentation?

1. Intrauterine pregnancy
2. Polycystic ovaries
3. Ectopic pregnancy
4. Follicular cyst rupture
5. Corpus luteum cyst rupture

14. A 22-year-old woman presents to the ED with diffuse pelvic pain and vaginal She reports that it is about the same time when she normally has her menses. She also reports some pain with defecation, dys- pareunia, and points of dysmenorrhea in the past. The patient states that she has felt this way before, but that the pain has now worsened and is intolerable. Her physical examination reveals a soft abdomen with normal bowel sounds without rebound tenderness. The patient does not guard and there is no costovertebral tenderness. Her pelvic examination is significant for blood in the posterior vaginal vault, a closed os and no palpable masses or cervical motion tenderness. Given this patient’s history and physical examination, which of the following is the most likely diagnosis?

1. Ureteral colic
2. Pregnancy
3. Ruptured ectopic pregnancy
4. Endometriosis
5. Appendicitis

15. A 51-year-old woman presents to the ED with heavy vaginal She reports that she has bleeding for 12 consecutive days. She also reports missing a period 3 months ago, with an ensuing menses that she states was quite heavy. She denies having any hot flashes, vaginal dryness, night sweats, or changes in weight. The patient further denies any abdominal or back pain, syncope, and palpitations but states that recently she often feels lightheaded and cannot perform her normal activities of daily living. Her initial vital signs include HR of 110 beats per minute, BP of 140/88 mm Hg, and RR of 18 breaths per minute with oxygen saturation of 98% on room air. Upon physical examination, she appears pale with a nontender abdo- men and warm skin. Her pelvic examination reveals blood clots in the vagi- nal vault with a closed os, an enlarged uterus, and no adnexal tenderness. An ultrasound is performed that does not show any abnormalities. Which of the following diagnostic tests is most appropriate for this patient?

1. Endometrial biopsy
2. Hormonal therapy trial
3. Laparoscopic examination
4. Dilation and curettage
5. Hysterectomy  and salpingectomy

16. A 29-year-old G1P0010 presents to the ED with sharp, right-sided flank pain of acute onset associated with The pain began approxi- mately 1 hour before arrival. She denies any fever, hematuria, vomiting, change in bowel habit, or sick contacts. She cannot recall her LMP at this time. The patient is afebrile and her vitals are within normal limits when you begin your physical examination, which reveals a soft abdomen with mild diffuse tenderness to palpation without rebound. The patient has exquisite right flank pain. An initial urine dip is negative. Given the information you have so far, which of the following is the most probable diagnosis?

1. Appendicitis
2. PID
3. Ectopic pregnancy
4. Ureteral stone
5. Diverticulitis
6.  

17. A 23-year-old G1P0 presents to the ED with vaginal spotting that began earlier in the She denies any abdominal pain, trauma, dysuria, or back pain. Her initial vital signs include HR of 90 beats per minute, BP of 125/60 mm Hg, and RR of 14 breaths per minute with oxygen satura- tion of 99% on room air. Her pelvic examination is significant for a scant amount of blood in the posterior vaginal vault and a closed os. The patient has no tenderness upon bimanual examination. She states that she is 6 weeks pregnant. Given this patient’s presentation, which of the following ancillary tests must be performed?

1. CBC
2. Basic metabolic panel
3. Coagulation panel
4. Type and screen
5. Urinalysis

18. A 22-year-old woman presents to the ED with vaginal bleeding that began earlier in the She reports that her LMP was 3 weeks ago. She denies any metromenorrhagia in the past. Upon physical examination, her cervical os is closed with clots in the posterior vaginal vault. There is no adnexal or cervical motion tenderness. She has mild abdominal cramps but no localizing pain. Her pregnancy test is negative. Given this patient’s clinical presentation, what is the most likely diagnosis?

1. Threatened abortion
2. Normal menstrual flow
3. Ectopic pregnancy
4. Dysfunctional  uterine bleeding
5. PID

19. A 26-year-old G1P1001 presents to the ED with vaginal spotting for the last 3 days with occasional left-sided pelvic Her physical examina- tion includes a closed cervical os, scant blood within the vaginal vault with left adnexal tenderness. Given this patient’s history and physical exam- ination, you suspect an ectopic pregnancy. In addition to a quantitative b-hCG, which of the following laboratory tests may prove helpful in the evaluation of this patient?

1. Estrogen level
2. Follicle-stimulating hormone (FSH) level
3. Thyrotropin (TSH) level
4. Progesterone level
5. CBC

20. A 30-year-old woman with no prior pregnancies presents to the ED with diffuse pelvic pain and vaginal spotting. The following transvaginal ultrasound is performed and shown What is the minimum b-hCG level needed to obtain this sonographic image?

1. 1000 mIU/mL
2. 950 mIU/mL
3. 1500 mIU/mL
4. 4000 mIU/mL
5. 6500 mIU/mL

21. A 32-year-old G2P1001 presents to the ED with severe abdominal pain and vaginal She reports that she is currently in her third tri- mester and that she has been diagnosed and treated for preeclampsia. Her vitals are significant for a BP of 195/100 mm Hg. Upon physical examina- tion, her abdomen is distended and hard to the touch. Given this patient’s history and physical examination, what emergent intervention is most appropriate?

1. Ultrasound
2. Pelvic examination
3. Tocolytics
4. Blood transfusion
5. Maternal/fetal monitoring with possible  delivery

22. A 28-year-old G2P0010 presents to the ED stating that she is preg- nant and has vaginal spotting of Pelvic examination reveals blood in the vaginal vault, but no active bleed, and a closed internal os. Transvaginal ultrasound reveals an intrauterine pregnancy consistent with a gestational age of 11 weeks. Her BP is 130/75 mm Hg, HR is 82 beats per minute, temperature is 99.1°F, and RR is 16 breaths per minute. Laboratory results reveal a WBC 10,500/μL, hematocrit 40%, and platelets 225/μL. She is blood type B, Rh-negative. Which of the following is the most appropriate intervention before discharging the patient from the ED?

1. Administer 50 μg of anti-D immune globulin.
2. Administer 2 g of magnesium sulfate to prevent eclampsia.
3. Administer penicillin G to prevent chorioamnionitis.
4. Administer ferrous sulfate to prevent anemia.
5. Administer packed red blood cells to increase blood volume.

23. A 4-year-old girl presents to the ED with her mother for a concern that she has been sexually The mother bases this concern on a small amount of vaginal spotting that she noted in the patient’s underwear this morning. The patient has no complaints and denies any abuse. Addi- tional history is difficult due to the patient’s age. Your physical examination is unremarkable. Regarding this patient, which of the following statements is true?

1. A pelvic examination should never be performed in the ED on a patient this young due to the risk of fistula formation.
2. The patient should immediately be transferred to a certified rape-examination center for evidence collection.
3. The most likely cause of her symptoms is a vaginal foreign body.
4. The patient should be evaluated for a bleeding disorder such as von Willebrand disease.
5. Reassure the mother that this is normal and that no specific intervention is required.

24. An 84-year-old woman presents to the ED after she noticed a small amount of vaginal spotting in her underwear over the last several She states that she is sexually active. She denies shortness of breath and weakness and has not noticed any other bleeding or bruising. Her BP is 130/75 mm Hg, HR is 82 beats per minute, temperature is 98.1°F, and RR is 16 breaths per minute. Her physical examination is unremarkable with the exception of a smooth, shiny, and friable epithelium and introital stenosis of less than 2 cm on pelvic examination. Regarding this patient, which of the following statements is true?

1. She should immediately undergo a complete evaluation, including a CBC, prothrombin time/partial thromboplastin time/international normalized ratio (PT/PTT/INR), type and screen, and CT scan of the abdomen and pelvis for staging.
2. The gynecology service should be consulted for emergent endometrial biopsy.
3. Reassure the patient that vaginal bleeding is part of the normal aging process and that additional evaluation is not required.
4. She should be evaluated for a bleeding disorder such as von Willebrand disease.
5. She should be advised to seek outpatient follow-up for serum hormone levels and Papanicolaou smear.