Case Scenario 1
Table 1
Standard level of HCG during pregnancy.
GA weeks
HCG level
3 weeks LMP
4 weeks LMP
5 weeks LMP
6 weeks LMP
7-8 weeks LMP
9-12 weeks LMP
13-16 weeks LMP
17-24 weeks LMP
25-40 weeks LMP
Non pregnant
Table 2
Scenario
A normal ongoing pregnancy, the expectation for the beta HCG level is to _____ (hint: increase by how much) within 48-72 hours
During a spontaneous abortion (miscarriage), the
expectation for the beta HCG level is to ____ (hint:
decrease by how much) within 48-72 hour
During an ectopic pregnancy, the expectation for the beta HCG level is to ____ within 48-72 hour
During a gestational trophoblastic pregnancy, the expectation for the beta HCG level is to ____ within 4872 hour
Table 3
Common complaints during pregnancy.
Keep in mind these symptoms are during pregnancy, make sure the cause,
presentation, and treatment is related to pregnancy status of the patient.
Definition
and Cause
Presentation Treatment
(include
possible DDX)
Education
Constipation
Back pain
GERD
Fatigue
Heart palpitations
Urinary frequency
Nausea and
Vomiting
Round ligament
pain
Hyperpigmentation
Sleep disturbance
Tonia is an 18-year-old female who presents to your office complaining of two
months of amenorrhea. Her pregnancy test is positive and her LMP indicates she
is 5.6 weeks EGA. She reports she has had some bleeding for the past 3 days, that
started as spotting, but has continued to be a light period- like bleeding today. She
denies any pain. She indicates plans to continue the pregnancy.
1. Subjective:
a. What other relevant questions should you ask regarding the HPI?
b. What other medical history questions should you ask?
c. What other social history questions should you ask?
2. Objective:
a. Describe all elements of the head-to-toe assessment you will perform
for her initial prenatal visit
b. Explain what test(s) you will order and perform, and discuss your
rationale for ordering and performing each test.
3. Assessment/ Diagnosis:
a. What are your presumptive and differential diagnoses, and why?
b. Any other diagnosis or differential diagnosis you would like to add?
c. Assume you ordered an HCG today and the result was 1200. She
returns to the clinic in 2 days and her HCG results is 550. What would
be her diagnosis?
4. Plan:
a. How will you explain the HCG results to your patient?
b. Explain treatment guidelines and side effects including any possible
side effects of the medication and treatment(s), partner notification,
and follow-up plan of care.
c. What patient education is important to include for this patient?
(Consider when can the patient resume sexual activity, birth control
options, when she can resume trying to conceive again).
Provide evidence from the research to support your decision-making.
Case Scenario 1
Table 1
Standard level of HCG during pregnancy.
GA weeks
HCG level
3 weeks LMP
4 weeks LMP
5 weeks LMP
6 weeks LMP
7-8 weeks LMP
9-12 weeks LMP
13-16 weeks LMP
17-24 weeks LMP
25-40 weeks LMP
Non pregnant
Table 2
Scenario
A normal ongoing pregnancy, the expectation for the beta HCG level is to _____ (hint: increase by how much) within 48-72 hours
During a spontaneous abortion (miscarriage), the expectation for the beta HCG level is to ____ (hint:
decrease by how much) within 48-72 hour
During an ectopic pregnancy, the expectation for the beta HCG level is to ____ within 48-72 hour
During a gestational trophoblastic pregnancy, the expectation for the beta HCG level is to ____ within 4872 hour
Table 3
Common complaints during pregnancy.
Keep in mind these symptoms are during pregnancy, make sure the cause,
presentation, and treatment is related to pregnancy status of the patient.
Definition
and Cause
Presentation Treatment
(include
possible DDX)
Education
Constipation
Back pain
GERD
Fatigue
Heart palpitations
Urinary frequency
Nausea and
Vomiting
Round ligament
pain
Hyperpigmentation
Sleep disturbance
Tonia is an 18-year-old female who presents to your office complaining of two
months of amenorrhea. Her pregnancy test is positive and her LMP indicates she
is 5.6 weeks EGA. She reports she has had some bleeding for the past 3 days, that
started as spotting, but has continued to be a light period- like bleeding today. She
denies any pain. She indicates plans to continue the pregnancy.
1. Subjective:
a. What other relevant questions should you ask regarding the HPI?
b. What other medical history questions should you ask?
c. What other social history questions should you ask?
2. Objective:
a. Describe all elements of the head-to-toe assessment you will perform for her initial prenatal visit
b. Explain what test(s) you will order and perform, and discuss your rationale for ordering and performing each test.
3. Assessment/ Diagnosis:
a. What are your presumptive and differential diagnoses, and why?
b. Any other diagnosis or differential diagnosis you would like to add?
c. Assume you ordered an HCG today and the result was 1200. She returns to the clinic in 2 days and her HCG results is 550. What would be her diagnosis?
4. Plan:
a. How will you explain the HCG results to your patient?
b. Explain treatment guidelines and side effects including any possible side effects of the medication and treatment(s), partner notification, and follow-up plan of care.
c. What patient education is important to include for this patient?
(Consider when can the patient resume sexual activity, birth control
options, when she can resume trying to conceive again).
Provide evidence from the research to support your decision-making.
