Vaginal Bleeding Flashcards
What key history would you obtain from a patient who complains of vaginal bleeding?
Pre vs postmenopausal Duration Amount Menstrual history and relation to LMP Associated discharge Pelvic or abdominal pain Urinary symptoms Trauma Medications (especially warfarin, contraceptives) History of easy bleeding or bruising History of abnormal Pap smears Pregnancy?
What key physical exams would you perform on a patient who complains of vaginal bleeding?
Vital signs
Abdominal exam
Complete pelvic exam
17 yo F presents with prolonged, excessive menstrual bleeding occurring irregularly over the past six months. Differentials?
Dysfunctional uterine bleeding Coagulation disorders (e.g. von Willebrand's disease, hemophilia) Cervical cancer Molar pregnancy Hypothyroidism Diabetes mellitus
17 yo F presents with prolonged, excessive menstrual bleeding occurring irregularly over the past six months. Differentials: dysfunctional uterine bleeding, coagulation disorders (e.g. von Willebrand’s disease, hemophilia), cervical cancer, molar pregnancy, hypothyroidism, diabetes mellitus. Workup?
Pelvic exam Urine hCG Cervical culture, Pap smear CBC/ESR Glucose PT/PTT Prolactin LH/FSH TSH U/S - pelvis
61 yo obese F presents with profuse vaginal bleeding over the past month. Her last menstrual period was 10 years ago. She has a history of hypertension and diabetes mellitus. She is nulliparous. Differentials?
Endometrial cancer Cervical cancer Atrophic endometrium Endometrial hyperplasia Endometrial polyps Atrophic vaginitis
61 yo obese F presents with profuse vaginal bleeding over the past month. Her last menstrual period was 10 years ago. She has a history of hypertension and diabetes mellitus. She is nulliparous. Differentials: endometrial cancer, cervical cancer, atrophic endometrium, endometrial hyperplasia, endometrial polyps, atrophic vaginitis. Workup?
Pelvic exam Pap smear Endometrial biopsy U/S - pelvis Endometrial curettage Colposcopy Hysteroscopy
45 yo G5P5 F presents with postcoital bleeding. She is a cigarette smoker and takes OCPs. Differentials?
Cervical cancer
Cervical polyps
Cervicitis
Trauma (e.g. cervical laceration)
45 yo G5P5 F presents with postcoital bleeding. She is a cigarette smoker and takes OCPs. Differentials: cervical cancer, cervical polyps, cervicitis, trauma. Workup?
Pelvic exam
Pap smear
Colposcopy and biopsy
28 yo F who is eight weeks pregnant presents with lower abdominal pain and vaginal bleeding. Differentials?
Spontaneous abortion
Ectopic pregnancy
Molar pregnancy
28 yo F who is eight weeks pregnant presents with lower abdominal pain and vaginal bleeding. Differentials: spontaneous abortion, ectopic pregnancy, molar pregnancy. Workup?
Pelvic exam Urine hCG U/S - pelvis CBC PT/PTT Quantitative serum hCG
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 five weeks ago. She has a history of PID and unprotected intercourse. Differentials?
Ectopic pregnancy
Ruptured ovarian cyst
Ovarian torsion
PID
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 five weeks ago. She has a history of PID and unprotected intercourse. Differentials: ectopic pregnancy, ruptured ovarian cyst, ovarian torsion, PID. Workup?
Pelvic exam Urine hCG Cervical cultures U/S - pelvis Quantitative serum hCG
