Prep for USMLEPrep for USMLE
         Forum      |     Resources New Posts   |   Register   |   Login





 OB/Gyn question 1  



Post Reply  
  • 0/5
  • 1
  • 2
  • 3
  • 4
  • 5
Which is the next appropriate step in diagnosis?
< 1 month
0 0%
< 1 month
0 0%
< 1 month
0 0%
< 1 month
0 0%
at home
0 0%
I am too shy.
0 0%
Serum hCG
0 0%
change the layout
0 0%
5
0 0%
QBank is easier than the actual exam
0 0%
BRS
0 0%
< 1 week
0 0%
IMG W/O US clinical experience
0 0%
yes -piece of cake
0 0%
Choice # 1
0 0%
Choice 1
0 0%
kaplan
0 0%
UASD
0 0%
less than 1 week
0 0%
less than 10
0 0%
Yes
0 0%
1-3 hours
0 0%
Yes
0 0%
immuno/mol.bio
0 0%
<1 month
0 0%
Very satisfied, looking forward to chat with others
0 0%
less than 2 months
0 0%
First aid
0 0%
for application status letter from California med.
0 0%
relaxed
0 0%
George W. Bush
0 0%
Doing your PG here in india
0 0%
1. Anti-DSDNA
0 0%
NMS Step 1
0 0%
I proficient in english language
0 0%
Falcon
0 0%
Kaplan+BRS+QBANK
0 0%
Medical Boards Step II Made Ridiculously Simple
0 0%
Kaplan Physiology
0 0%
after first reading
0 0%
yes
0 0%
Yes
0 0%
HELP
0 0%
Strong Medicine
0 0%
reply soon
0 0%
>95
0 0%
about getting resi this yr
0 0%
yes
0 0%
H1
0 0%
FA
0 0%
IMG
0 0%
Yes
0 0%
Yes
0 0%
Los Angeles
0 0%
1
0 0%
Excellent
0 0%
online study partner/s
0 0%
family medicine
0 0%
Robbins review
0 0%
urgent
0 0%
Yes
0 0%
even silly things in exam time looks important
0 0%
1-2 months
0 0%
1-2 months
0 0%
1-2 months
0 0%
1-2 months
0 0%
at the library
0 0%
I ve got no time. ( Must study. )
0 0%
Serum TSH
0 0%
pages load too slow
0 0%
4
0 0%
QBank is harder than the actual exam
0 0%
hi yeild
0 0%
1-2 weeks
0 0%
IMG with US clinical experience
0 0%
yes -but its hard
0 0%
Choice # 2
0 0%
Choice 2
0 0%
falcon
0 0%
UNIBE
0 0%
1-2 weeks
0 0%
10 - 20
0 0%
No
0 0%
4-5 hours
0 0%
No
0 0%
path/pharm
0 0%
1-2 months
0 0%
Not satisfied, will not use the chat in the future
0 0%
3 months
0 0%
Questions
0 0%
california residency
0 0%
worried and anxious
0 0%
John Kerry
0 0%
USMLE
0 0%
2. Anti-Smith
0 0%
Step UP
0 0%
I have clinical experience
0 0%
Kaplan
0 0%
Kaplan+High Yield+QBank
0 0%
First AID Step II
0 0%
STARS Physiolgy
0 0%
after second reading
0 0%
Very Good
0 0%
no
0 0%
No
0 0%
PREPARATION
0 0%
First Aid
0 0%
step 2cs notes
0 0%
90-95
0 0%
residency in 2005
0 0%
no
0 0%
J1
0 0%
Step-Up
0 0%
AMG
0 0%
No
0 0%
No
0 0%
Philadelphia
0 0%
2
0 0%
Good
0 0%
online discussions in chat room ( everyday )
0 0%
internal medicine
0 0%
QBank
0 0%
please
0 0%
No
0 0%
a Question
0 0%
3-4 months
0 0%
3-4 months
0 0%
3-4 months
0 0%
3-4 months
0 0%
at the bookstore
0 0%
I dont have a keyboard.
0 0%
abdominal x-ray
0 0%
needs more content
0 0%
3
0 0%
QBank is comparable to the actual exam
0 0%
Blueprints
0 0%
2-3 weeks
0 0%
no-i gave up a long time ago
0 0%
Choice 3
0 0%
UTESA
0 0%
2-3 weeks
0 0%
20 - 30
0 0%
Prematch
0 0%
6-7 hours
0 0%
no such difference exists
0 0%
3-4 months
0 0%
4 months
0 0%
Goljan
0 0%
hopeless and down
0 0%
Other
0 0%
PLAB
0 0%
3. Same specificity, question irrelevant?
0 0%
Board Simulator Series
0 0%
I have good communication skills
0 0%
Kaplan+QBank
0 0%
Crush the Boards Step II [ ADAM BROCHART ]
0 0%
Fair
0 0%
help
0 0%
85-89
0 0%
how to get it this yr
0 0%
Some other route except green card - please specify
0 0%
USMLE Step 1 Secrets
0 0%
Atlanta
0 0%
3
0 0%
Change your plan - It may work out...
0 0%
online discussions in chat room ( once or twice in a wk )
0 0%
paeds
0 0%
Not Sure
0 0%
5-6 months
0 0%
5-6 months
0 0%
5-6 months
0 0%
5-6 months
0 0%
at a cafe
0 0%
I dont speak this language.
0 0%
abdominal/pelvic CT
0 0%
add more features
0 0%
2
0 0%
QBank is totally not comparable to the actual exam
0 0%
3-4 weeks
0 0%
Choice 4
0 0%
UCE
0 0%
more than 3 weeks
0 0%
30- 40
0 0%
Never - ain't going to do it.
0 0%
8 hours
0 0%
other heavily emphasized topic
0 0%
5-6 months
0 0%
5 months
0 0%
kaplan notes
0 0%
did not think about it much
0 0%
USMLE Step 1 SECRETS
0 0%
Kaplan+First AID+QBank
0 0%
Kaplan [OLDER VERSION]--New version is not available!
0 0%
Poor
0 0%
80-84
0 0%
residency after scramble
0 0%
Chicago
0 0%
4
0 0%
Alas!!! It won't work out....
0 0%
study alone
0 0%
neurology
0 0%
> 6 months
0 0%
> 6 months
0 0%
> 6 months
0 0%
> 6 months
0 0%
at the 24h open supermarket
0 0%
I dont want to share.
0 0%
pelvic ultrasound
0 0%
1
0 0%
> 1 month
0 0%
Choice 5
0 0%
UCMM
0 0%
40 - 50
0 0%
More than 9 hours
0 0%
>6 months
0 0%
6 months
0 0%
BRS+First AID+QBank
0 0%
75-79
0 0%
after scramble
0 0%
Houston
0 0%
5
0 0%
psychiatry
0 0%
I only answer board format questions.
0 0%
Laparascopy
0 0%
UNPHU
0 0%
6-9 months
0 0%
High Yield+First AID+QBANK
0 0%
70-74
0 0%
Doesn't matter
0 0%
6
0 0%
dermatology
0 0%
1 year or more
0 0%
First AID+QBANK
0 0%
<70
0 0%
7
0 0%
radiology
0 0%
8
0 0%
surgery
0 0%
9
0 0%
ob-gyn
0 0%
10
0 0%
0 votes



Author21 Posts
  #1

A 23-year old woman presents with the following chief complaint:
Right lower quadrant pain and vaginal spotting.

Last menstrual period was 5 weeks ago.

Temperature is 98F( 37 C ),
blood pressure 112/70,
pulse 73/ min,
respirations 14/min.

Abdomen is soft and non tender.
Pelvic examination: Scant blood in the vagina, cervical os closed, no pelvic masses, a right pelvic tenderness.
Leucyte count 8000,
Hkt. 38%,
platelets 250,000.

Which is the next appropriate step in diagnosis?




  #2

5 weeks ago last period ... seems like a first trimester bleeding. Must be sure she's pregnant so I think HCG should be the fist step because pelvic US it's too early. She has stable vital signs.


what is the answer ?
nice question


  #3

Good idea!

Well , shouldnt we wait until at least 95 ( or 10 ) people have posted their thoughts? Otherwise it s no fun!

Will promise to post the answers then! :wink: ( I ll post the answer tomorrow! )


  #4

The answer is: hCG.

Of course I ask myself, how could there have been a venipuncture for obtaining Leucocyte, Thrombocyte, platelets and Hkt counts and not hCG yet? Is it too expensive?

Any woman presenting at child bearing age with vaginal bleeding should have one.

If the hCG was done, then wouldn’t I have to do a pelvic ultrasound? It would be too early to see the pregnancy ( yeah , you re right! ), but wouldn’t I miss to see other pain causing things like e.g. exsudates/torsions ?

The amenorrhea, abdominal pain and vaginal bleeding speak for a possible ectopic pregnancy. This would go along with a very high serum hCG. ( so only urine dipstick hCG wouldn’t be sufficient ).

Major complication of ectopic pregnancy is Fallopian Tube rupture and can lead to death.

----------------------------------------------------------------------------

TSH: The idea behind obtaining a TSH is, evaluation of menstrual irregularities. Both Hypo- and Hyperthyreodism can be a reason for it. That s not an acute question though.

Abdomen-X-Ray: It s useful for finding free air in the abdomen after perforation, finding the typical picture of an Ileus or finding stones ( renal or gallstones ). It usually comes with a typical clinic. Ileus ( listen to bowel movement ) or stones ( localized pain ). Actually you would always want to make shure that a woman in childbearing age is for shure NOT pregnant before you take an x-ray.

Pelvic/Abdominal CT: Is usually not a first step in diagnostics. It s simply too expensive!
You can use it to help localizing tumors or abcesses. Because of the radiation same rule applies for women at childbearing age.

Laparascopy: Lot s of things need to be done before a laparascopy. Even in a real emergency, you need hCG, bloodtype, and would do e.g. pelvic ultrasound, call the anaestisiologist etc. But once the ectopic pregnancy is diagnosed, you would consider it a an instrument.

Have a nice weekend!



  #5

Hi,
What if the HCG option would not be there or assume that it has been done and the patient is pregnant. I wonder what would be the choice then, US or Rx?

Thanks for the question.
Beast of luck !


  #6

Hi Test,

What if the HCG option would not be there or assume that it has been done and the patient is pregnant. I wonder what would be the choice then, US or Rx?


I assume you mean Xray by Rx? I think the US should be done.


  #7

For board purposes, every qs related to vaginal bleeding/ or RLQ pain, ectopic pregnancy and HCG is crucial.


  #8

If nobody has something against I want to continue this case with the scenario:

hCG comes back positive. What is the best next step in the management:

1. transabdominal US
2. transvaginal US
3. repeat hCG in 48 hours
4. laparotomy
5. laparoscopy


  #9

all we know is that the woman is pregnant, has a rlq pain and has some blood coming out of her vagina so I think that at this moment we should have the transabdominal US to check if there is fluid/blood in the abdominal cavity(especially in Dougla's pouch)


  #10

transabdominal US and if - repeat the hcg after 48 hours ?


  #11

unless ofcourse she has non of the symptoms of acute abdomen


  #12

A positive HCG should be correlated with a sonogram for a diagnostic of pregnancy. A sonogram may show a normal or ectopic or a molar pregnancy as well.
The book says that the transabdominal sonogram can see a baby at 6 weeks. This lady had her last pregnancy 5 weeks before so the transabdominal sonogram may not show the baby.
On the other hand the transvaginal sonogram can see the baby at 4 weeks and should be done for this lady if the transabdominal one is negative.
If the transvaginal sonogram is negative, then the HCG should be repeated in 48 hours and see if it's value is doubled.

Ole!


  #13

hmmmmm .... nice MCQ even though it has been there for ages ....I just noticed it now....

Well i hope again no one has a problem with me adding a bit to it....

So ...this patient comes with the same findings except that she is slightly sick ....severe abdominal pain and tenderness with low HCT and etc....
and her B- HCG is +ve and her vaginal Sono is -ve......
what wld be the next step:

1...serial HCG
2...culdocentesis
3...Laparoscopy
4....reassurance :P
5...methotrexate
6....Dilatation and curretage


  #14

2...culdocentesis ?


  #15

repeat hcg


  #16

definitely culdocentesis..........


  #17

2 is the next best option


  #18

#3, #2 can be used,but then #3 would be used next to be more accurate.also less chance of tubal rupture if she is is severe pain.The ectopic can be removed at that time.


  #19

Culdo centices is the best I think Because Laproscopy is thr RX But it has to be confirmed that it is Ectopic Pregnancy.
I would go with Culdocentices.


  #20

Culdo centices is the best I think Because Laproscopy is thr RX But it has to be confirmed that it is Ectopic Pregnancy.
I would go with Culdocentices.





Bookmark and Share



This thread is closed, so you cannot post a reply.



Login or Register to post messages








show Similar forum topics

OB/Gyn link
OB-Gyn Q1
OB-Gyn Q2
show Related resources

Conrad Fischer's Internal Medicine Question Book
Underground Clinical Vignettes: Ob/Gyn








Advertise | Support | Premium | Contact