Case 5 - 28 yo F after positive pregnancy test

Question 1

Information gathering

Answer 1

CC
Onset/duration
LMP
Age at menarche
Menstrual Hx
Pain with periods
Spotting between periods
Contraception
Pregnancy Hx
Sexual activity
Hx of STDs
Associated symptoms (N/V)
Postcoital bleeding
Abdominal pain
Appetite changes
Weight changes
Fatigue
Breast discharge/tenderness
Last Pap smear
Fevers
Bowel habits
Urinary habits
SOB
Skin changes
Exercise
Intent to become pregnant
PMHx (including history of STDs)
PSHx
FHx
Social Hx (occupation, tobacco, alcohol, drug use, diet and exercise)
Planned pregnancy
Desired pregnancy
Domestic abuse

Question 2

Physical examination

Answer 2

HEENT exam (including thyroid exam)
CV exam
Pulmonary exam
Abdominal exam
Skin exam (inspect for pigmentation or pallor)

Question 3

Closure

Answer 3

Mentioned need for pelvic and breast exam
Repeat urine pregnancy test to confirm diagnosis
Perform pelvic ultrasound to estimate fetal age and date of delivery
If you are pregnant, we need to check more blood tests, a Pap smear and some vaginal cultures
Recommend stop alcohol and avoid intense exercise and excess caffeine
Prenatal multivitamins
I will advise you further as soon as we receive the test results
Do you have any questions or concerns?

Question 4

Differential diagnosis

Answer 4

Normal pregnancy
Ectopic pregnancy
Molar pregnancy

Question 5

Diagnostic work-up

Answer 5

Urine hCG (or quantitative serum beta-hCG if an abnormal pregnancy is suspected)
US - pelvis
Breast and pelvic exams
Blood type, Rh, antibody screen
CBC
TSH
RPR, rubella IgG, HBsAg, HIV antibody
Pap smear
Cervical gonorrhea and chlamydia DNA testing
UA and urine culture