Reference no: EM133953970

Question

A 34-year-old female presents to your primary care clinic with a 3-day history of dizziness, fatigue, and headache. She has 2 children, ages 5 and 2. She and her husband wants another child, hopefully a boy, and have planned accordingly. She missed her last period and suspects she is pregnant. An at home pregnancy test last week was positive. Until 5 days ago, she felt fine, other than some fatigue and mild nausea. Over the last 3 days, she began experiencing abdominal cramping and irregular vaginal bleeding. She points to both lower and upper quadrants as the main location of the pain. She describes her abdominal pain as 7 of 10. She has not used over-the-counter pain medication because she wants to avoid medication if pregnant. Additionally, she states, "When changing positions, I get lightheaded." When you ask about her bleeding, she states she has had similar bleeding during her other pregnancies. "All my pregnancies are like that, it's normal."

Review of systems: is positive for fatigue, nausea, abdominal pain, and vaginal bleeding. The patient reports headache and dizziness. The ROS is negative for fever, chills, vomiting, diarrhea, constipation, shortness of breath, or chest pain.

A urine pregnancy test (UA HCG) at the primary care clinic confirmed the pregnancy.

Questions:

1. What relevant questions would you ask in her history?

2. What are your top three differential diagnosis?

3. Should other tests/imaging studies be ordered? Which ones? Why? (Think about tests/imaging beyond the primary care setting as well.)

4. What are the next appropriate steps in management?

5. What specialties or other disciplines and indicate what contribution these professionals might make to managing this patient's care.