Key History
Pre- vs. postmenopausal status, duration, amount; menstrual history and relation to last menstrual period; associated discharge, pelvic or abdominal pain, or urinary symptoms; trauma; medications (especially blood thinners, contraceptives); history of easy bleeding or bruising; history of abnormal Pap smears.
Key Physical Exam
Vital signs; abdominal exam; complete pelvic exam.
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VAGINAL BLEEDING (cant'd) |
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Presentation |
Differential |
Workup |
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■ 17 yo F presents with prolonged, excessive menstrual bleeding occurring irregularly within the past 6 months. |
Dysfunctional uterine bleeding Coagulation disorder (eg, von Willebrand’s disease, hemophilia) Cervical cancer Molar pregnancy Hypothyroidism Diabetes mellitus |
Urine hCG Pelvic exam Cervical culture Pap smear CBC ESR Glucose PT/PTT LH/FSH, TSH, prolactin U/S—pelvis |
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■ 61 yo obese F presents with profuse vaginal bleeding for the past month. Her last menstrual period was 10 years ago. She has a history of hypertension and diabetes mellitus. She is nulliparous. |
Endometrial cancer Cervical cancer Atrophic endometrium Endometrial hyperplasia Endometrial polyps Atrophic vaginitis |
Pelvic exam Pap smear Endometrial biopsy Endometrial curettage U/S—pelvis Colposcopy Hysteroscopy |
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■ 45 yo G5P5 F presents with postcoital bleeding. She is a cigarette smoker and takes OCPs. |
Cervical cancer Endometrial cancer Cervical polyp Cervicitis Trauma (eg, cervical laceration) |
Pelvic exam Pap smear Colposcopy and biopsy HPV testing Endometrial biopsy |
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■ 28 yo F who is 8 weeks pregnant presents with lower abdominal pain and vaginal bleeding. |
Spontaneous abortion Ectopic pregnancy Molar pregnancy |
Urine hCG Quantitative serum hCG U/S—abdomen/pelvis Pelvic exam CBC PT/PTT |
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■ 32 yo F presents with sudden onset of left lower abdominal pain that radiates to the scapula and back and is associated with vaginal bleeding. Her last menstrual period was 5 weeks ago. She has a history of pelvic inflammatory disease and unprotected intercourse. |
Ectopic pregnancy Ruptured ovarian cyst Ovarian torsion Pelvic inflammatory disease |
Urine hCG Quantitative serum hCG U/S—abdomen/pelvis Pelvic exam Cervical cultures |
Key History
Amount, color, consistency, odor, duration; associated vaginal burning, pain, or pruritus; recent sexual activity; onset of last menstrual period; use of contraceptives, tampons, and douches; history of similar symptoms; history of STDs.
Key Physical Exam
Vital signs; abdominal exam; complete pelvic exam.
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Presentation |
Differential |
Workup |
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■ 28 yo F presents with a thin, grayish-white, foulsmelling vaginal discharge. |
Bacterial vaginosis Vaginitis—candidal Vaginitis—trichomonal Cervicitis (chlamydia, gonorrhea) |
Pelvic exam Wet mount, KOH prep, “whiff test” pH of vaginal fluid Cervical cultures |
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■ 30 yo F presents with a thick, white, cottage cheeselike, odorless vaginal discharge and vaginal itching. |
Vaginitis—candidal Bacterial vaginosis Vaginitis—trichomonal |
Pelvic exam Wet mount, KOH prep, “whiff test” pH of vaginal fluid Cervical cultures |
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■ 35 yo F presents with a malodorous, profuse, frothy, greenish vaginal discharge with intense vaginal itching and discomfort. |
Vaginitis—trichomonal Vaginitis—candidal Bacterial vaginosis Cervicitis (chlamydia, gonorrhea) |
Pelvic exam Wet mount, KOH prep, “whiff test” pH of vaginal fluid Cervical cultures |