The Rational Clinical Examination
David L. Simel, Drummond Rennie
John R. Crochet, Lori A. Bastian, Monique V. Chireau
Clinical Scenarios, Why Is This Question Important?, Methods, Results, Discussion, Scenario Resolution, Conclusions, References
"A 21-year-old college student with a remote history of 1 prior
miscarriage presents with 2 days of vaginal spotting and lower abdominal
discomfort. A urine pregnancy test at home showed a positive result.
Her last menstrual period was approximately 5 weeks ago, and she
has no risk factors for ectopic pregnancy (ie, history of ectopic
pregnancy or pelvic infection, current intrauterine contraceptive
device use, prior tubal or pelvic surgery). Her vital signs are
normal, and a physical examination is unremarkable. There is no
sign of either intrauterine pregnancy or ectopic pregnancy on transvaginal
sonography, and a serum human chorionic gonadotropin (hCG) level
is noted to be 1748 mIU/mL. ..."
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