CCS Interactive Case 2

Question 1

24 y/o F presents with N/V, amenorrhea over 7 weeks. Previously had regular cycles. No medical problems. Current smoker.

Physical exam steps?

Answer 1

Full

Question 2

Bilateral breast tenderness, bluish discoloration of vulva and vagina (Chadwick’s sign), globular uterus

Next step?

Answer 2

Beta-HCG (stat)

Question 3

Beta-HCG +

Next step?

Answer 3

Transvaginal ultrasound to confirm pregnancy is intrauterine, provide estimate of gestational age

Question 4

Next step?

Answer 4

Begin antenatal care:

Prenatal lab: Blood type, antibody screen, Rhesus type, CBC w/diff, BMP, Pap smear, Rubella antibodies, RPR, UA and urine culture (screens for UTI and asymptomatic bacteriuria), HepB surface Ag, HIV (ELISA) counseling and testing, Chlamydia testing

Question 5

Prenatal labs reserved for at risk patients?

Answer 5

Gonorrhea, TB, red cell indices (screen for thalassemia), Hgb electrophoresis, hexosaminidase A, CF carrier testing, serum phenylalanine level, toxo screen, hep C antibodies

Question 6

Therapy?

Answer 6

Prenatal vitamins
Iron sulfate
Folic acid
Prenatal counseling

Question 7

Monitoring?

Answer 7

F/u in 4 weeks

Question 8

Location?

Answer 8

Office, then Home