Vaginal Bleed with irregulat period 422/434

Question 1

task

Answer 1

CANDIDATE INFORMATION AND TASKS
Your patient is a 25-year-old married nulliparous woman who presents to you in a general practice
with vaginal bleeding after eight weeks of amenorrhoea. Her cycles are often irregular with the
periods occurring at intervals of 4-8 weeks.
YOUR TASKS ARE TO:
* Take a further focused history.
* Ask the examiner about the findings you wish to elicit on general and gynae- |
cological/obstetric examination.
* Advise the patient of the probable diagnosis and subsequent management, including any
investigations you would arrange.

Question 2

hx

Answer 2

-ask about periods, length, frequency, bleeding
-recongise mid cycle mucous?
-pregnancy symptoms : nausea, vomiting, breast discomfort
-current bleed : amount, colour, tissue, related sexual activity
-abdominal or pelvic pain
-contraception? any ideas of pregnancy
-pmh, shx, medic
-pap smear?
-blood group

Question 3

examination

Answer 3

-vitals
-abdominal : non tender, no viscous
-speculum: os, blood
-pelvic vaginal: uterus not enlarged, and introverted
-adnexal, normal non tender

Question 4

explanation

Answer 4

-diagnosis is unclear at this point from hx and exam
-we need to rule out pregnancy
-b hcg levels
-if negative late period>observe>if perisitently irregular >hormonal test to see if fertility treatment required>fsh,lh,tsh,prl
-if bhcg +>level>if greater 1000>USS to check site, normality, gestational date
-if pregnant probably a threatened miscarriage>no hormonal therapy required