401.A 28-year-old woman presents with severe abdominal pain with
distentionand vaginal bleeding. She reports being pregnant with a due
date in approximately 4 weeks. Her pain came on suddenly, shortly before
arrival to the ED. Upon further history-taking, the patient reports recent
cocaine use. What condition needs to be considered in this patient?
a. Uterine rupture
b. Normal contractions
c. Placenta accreta
d. Vasa previa
e. Ruptured ovarian cyst
402.A 24-year-old G2P0010 in her second trimester presents to the ED
with vaginal spotting for the past day. She denies any abdominal pain and
is otherwise in her usual state of health. Her vital signs are HR of 76 beats
per minute, BP of 120/65 mm Hg, respiratory rate (RR) of 16 breaths per
minute, and temperature 98.9°F. Which of the following conditions does
this patient most likely have?
a. Ectopic pregnancy
b. Placenta previa
c. Abruptio placentae
d. Uterine rupture
e. Ovarian torsion
403.A 24-year-old G3P1112 presents to the ED with vaginal bleeding
and clots. Her vital signs include a HR of 110 beats per minute, BP of
130/70 mm Hg, RR of 14 breaths per minute with an oxygen saturation of
99% on room air. She is afebrile and in mild distress. Recent medical his-
tory is significant for vaginal delivery 2 days ago with prolonged labor.
Pelvic examination is significant for a large, boggy uterus and a normal vagi-
nal wall. What is the mostlikely diagnosis in this patient?
a. Genital tract trauma
b. Endometritis
c. Uterine atony
d. Ectopic pregnancy
e. Uterine artery rupture
440 Emergency Medicine