Vaginal bleeding and lower abdominal pain
AMC Clinical practice station
History taking · 2 min to read · 8 min to perform
Try a real conversation · AMC ClinicalAI practice
Take a focused history.
Chloe JenkinsHi. I'm pregnant, I think, and I'm bleeding and it really hurts. I'm really scared.
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You are a doctor in a hospital emergency department. Chloe Jenkins, aged 28, has come in with vaginal bleeding and lower abdominal pain. She is alone. Take a focused history. Then tell her what you think the possible causes are, what you will do immediately and which tests you will arrange, and answer her questions. You can ask the examiner for observations and findings. The examiner will not otherwise take part.
What this station tests
- Pain, bleeding and a positive pregnancy test is an ectopic pregnancy until proven otherwise.
- Shoulder tip pain, dizziness and tachycardia suggest intraperitoneal bleeding; act before the ultrasound.
- Ask about risk factors: previous chlamydia or pelvic infection, an intrauterine device, tubal surgery and smoking.
- Group and screen, cannulas and senior and gynaecology review come first; anti-D depends on blood group.
- Be honest about uncertainty and offer to contact her support person.
Sources for the clinical content
- healthdirect: Ectopic pregnancy
- Pregnancy, Birth and Baby: Ectopic pregnancy
- Australian Commission on Safety and Quality in Health Care: Recognising and Responding to Acute Deterioration Standard
- Medical Board of Australia: Good medical practice, a code of conduct for doctors in Australia
An original practice scenario with invented patients. Not an exam question.