Vaginal Bleeding
Questions
399.A 23-year-old woman presents to the emergency department (ED) with
irregular menstrual bleeding. She denies any abdominal pain, dizziness, or
palpitations. The patient reports that her last menstrual period was 2 weeks ago
with normal flow and duration. Which of the following ancillary tests is critical
in defining the differential diagnosis for this patient?
a. Type and screen
b. Coagulation panel
c. β-Human chorionic gonadotropin (β-hCG)
d. Complete blood count (CBC)
e. No ancillary tests are needed
400.A 30-year-old G2P2 presents to the ED with acute onset of lower
abdominal pain associated with vaginal bleeding that began 2 hours prior
to arrival. She denies any prior medical history but does report having a tubal
ligation after the birth of her second child. Her vitals are significant for a heart
rate (HR) of 120 beats per minute and a blood pressure (BP) of 90/60 mm Hg.
On physical examination, the patient has right adnexal tenderness with blood
in the posterior vaginal vault. Her cervical os is closed. Given this patient’s
history and physical examination, which of the following is the most likely
diagnosis?
a. Appendicitis
b. Pelvic inflammatory disease (PID)
c. Placenta previa
d. Ectopic pregnancy
e. Abruptio placentae
439