Level 1: Vaginal Bleeding – Contrasting Case #3: 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 presents to the Student Health Center due to vaginal bleeding. She states that she has noticed blood on the toilet paper while wiping over the last couple of days. She has not had any spotting otherwise. Her LMP was 2 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 has also noticed that she has been urinating more frequently, and she complains of dysuria the past couple of days. She has suprapubic pain as well. She denies fatigue, fever/chills, back pain, and nausea/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. No acute distress.

Abdomen: Soft, non-distended. Bowel sounds present. No tenderness to light/deep palpation.

Genital: Normal appearing external genitalia. Cervix appears smooth without any lesions or masses. Vaginal vault is pink without lesions or masses. Bimanual exam unremarkable.

Extremities: No edema

Labs: U/A: +RBCs, >10 leukocytes/microL; Urine dipstick: +leukocyte esterase, + nitrites UTI