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Moderator's Section

Abnormal Uterine Bleeding

A 39-year-old G2P2 with a past medical history of type II diabetes and chronic hypertension presents with concerns of heavy menses that started six months ago. She notes that her menses have always been painful; however, the amount of bleeding has increased over this time.

Patients with abnormal uterine bleeding (AUB) pose an interesting opportunity for evaluation of the etiology of the bleeding. In order to fully evaluate these patients, one must first recognize that there is a broad differential diagnosis that includes both anatomic /structural abnormalities as well as nonstructural causes. Treatment of these patients should be tailored to the specific etiology.

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Aneuploidy Screening

A 29-year-old G1P0 presents for prenatal care at 11 weeks of gestation. She had an early ultrasound for dating at 7 weeks that showed a single, live intrauterine pregnancy. She has no family history of genetic conditions or mental retardation.

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A 36-year-old G3P2012 presents for contraception counseling. She has two children, ages 6 and 8, and she states she is unsure about her future plans for more children.

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Early Pregnancy Loss

A 36-year-old G4P0030 comes to your office for counseling. Her last menstrual period (LMP) was 8 weeks ago. She was seen in the Emergency Department over the weekend with spotting. She had an ultrasound which showed an intrauterine pregnancy (IUP) measuring 7 weeks with no fetal heartbeat. Her history is significant for 3 first trimester losses, two managed surgically, one managed medically.

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A 37-year-old G0 presents with a chief complaint of inability to become pregnant. She has been actively trying to conceive for the past 2 years. She reports a long history of infrequent menses, and her exam is significant for obesity, with a body mass index (BMI) of 43 kg/m2 and facial acne. Her medical history is otherwise notable for hypothyroidism on Synthroid and a remote history of chlamydia as a teenager. Her partner is a 34-year-old male with no children of his own. He is generally healthy but smokes 2 packs cigarettes per day and reports occasional marijuana use. They are having unprotected intercourse approximately once a week. She is not using ovulation predictor kits.

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Pelvic Floor Disorders

A 56-year-old G3P3003 presents to the office with concerns of urinary incontinence. She reports leakage of urine for the past 5 years with progressively worsening symptoms. She also complains of a ‘bulge’ and vaginal pressure after long periods of standing. Her history is notable for 3 prior term vaginal deliveries. She is postmenopausal since age 52 years old and has not been on hormonal replacement therapy. She is monogamous with her partner and is sexually active.

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Sexual Transmitted Infections

A 20-year-old G0 presents for her first gynecology visit to establish well-woman care. She is sexually active with both male and female partners and is not currently using any contraception. She is asymptomatic and does not currently desire pregnancy.

How do you counsel her about risks of unprotected sexual activity and indicated screening tests for sexually transmitted infections (STIs)?

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A 28-year-old G2P2 presents to the office with concerns of vaginal irritation and discharge for the past two days. She reports clear vaginal discharge associated with itching and burning. She has no other significant past medical history.

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