Level 1: Vaginal Bleeding – Contrasting Case #1: Patient Information

Given these changes from the original case, what is your diagnosis?

What is your diagnostic explanation?

As compared to the long case, this patient is a 23 year old female who presents to the Student Health Center with the chief complaint of vaginal bleeding. She states that she has had intermittent vaginal bleeding for the past couple of days. She has only needed a light pad throughout these days. She is concerned because she was supposed to start her period 2 weeks ago. Her LMP was 6 weeks ago. Her menstrual cycles usually occur every 28 days, and they last for about 5 days. She normally uses 4-6 regular tampons/day. She is sexually active with her boyfriend, and they use condoms irregularly. She does not use any other form of contraception. She also complains of lower abdominal pain for the past few days. The pain is sharp and constant, and it came on abruptly a few days ago. She also has felt slightly nauseated and fatigued the past few days. The nausea is worse in the mornings. It occurs on and off, and it is not related to meal times. She has not noticed anything in particular that has aggravated or relieved the nausea. She has also noticed that she has been urinating more frequently, but she denies any dysuria. She denies fever/chills, weight loss/gain, constipation, diarrhea, and vomiting. She has never experienced similar symptoms before.

VS: Temp 98.6, HR 72, BP 122/78, RR 14, Height 5’5”, Weight 170, BMI 28.3

General: Alert and oriented. Patient appears slightly uncomfortable due to pain.

Abdomen: Soft, non-distended. Bowel sounds present. Tenderness to light palpation in lower quadrants. No rebound tenderness.

Genital: Normal appearing external genitalia. Active bleeding from cervix without visible lesions or masses, vaginal mucosa is pink without visible lesions or masses, bimanual exam is unremarkable

Labs: bhCG- positive, repeat serial bhCG

Transvaginal Ultrasound: Reveals gestational sac outside the uterus