Vaginal bleeding Flashcards
Key history in vaginal bleeding
Pre- vs. post-menopausal, duration, amount; menstrual history and relation to last menstrual period; associated
discharge, pelvic or abdominal pain, or urinary symptoms; trauma; medications (especially warfarin,
contraceptives); history of easy bleeding or bruising; history of abnormal Pap smears
Key physical exam in vaginal bleeding
Vital signs; abdominal exam; complete pelvic exam
17 yo F with prolonged, excessive menstrual bleeding occurring irregularly over last six months
Dysfunctional uterine bleeding Coagulation disorder (e.g. von Willebrand's disease, hemophilia) Cervical cancer Molar pregnancy Hypothyroidism Diabetes mellitus
Pelvic exam Urine hCG Cervical cultures, Pap smear CBC, ESR, glucose PT/PTT LH/FSH, prolactin TSH U/S—pelvis
61 yo obese F with profuse vaginal bleeding over last month
+ LMP was 10 years ago
+ Hx of HTN and DM
+ nulliparous
Endometrial cancer Cervical cancer Atrophic endometrium Endometrial hyperplasia Endometrial polyps Atrophic vaginitis
Pelvic exam Pap smear Endometrial biopsy U/S—pelvis Endometrial curettage Colposcopy Hysteroscopy
45 yo G5P5 F with postcoital bleeding
+ cigarette smoker
+ takes OCPs
Cervical cancer Endometrial cancer Cervical polyp Cervicitis Trauma (e.g., cervical laceration)
Pelvic exam Pap smear Colposcopy and biopsy HPV testing Endometrial biopsy
28 yo F who is eight weeks pregnant presents with lower abdominal pain and vaginal bleeding
Spontaneous abortion
Ectopic pregnancy
Molar pregnancy
Pelvic exam Urine hCG Quantitative serum hCG U/S—abdomen/pelvis CBC, PT/PTT
32 yo F with sudden onset LLQ pain radiating to scapula and back \+ vaginal bleeding \+ LMP five weeks ago \+ Hx of PID \+ unprotected intercourse
Ectopic pregnancy
Ruptured ovarian cyst
Ovarian torsion
PID
Pelvic exam Urine hCG Cervical cultures U/S—abdomen/pelvis Quantitative serum hCG
