OB/GYN - GYNECOLOGY + REPRODUCTIVE HEALTH

YEAR 3 | PAGE 30G - PREGNANCY TEST -> STABILITY -> SYNDROME -> PATIENT-CENTERED PLAN

F. GYNECOLOGIC PRESENTATIONS - BUILD THE DIFFERENTIAL BY SYNDROME

Presentation	High-yield discriminators	Management logic to practice
Acute pelvic / lower abdominal pain	Pregnancy possibility, hemodynamics, sudden vs gradual onset, unilateral pain, fever/discharge, peritoneal signs, adnexal mass.	Pregnancy test early when relevant. Exclude ectopic pregnancy and ovarian torsion before settling on PID, cyst, endometriosis, GI or urinary causes.
First-trimester bleeding	Pregnancy location/viability, pain, cervical findings, hemodynamics, beta-hCG/ultrasound relationship and Rh context.	Separate threatened/early pregnancy loss from ectopic and other causes; unstable bleeding changes the sequence immediately.
Abnormal uterine bleeding	Pregnancy status, age, bleeding severity, anemia, ovulatory pattern, medications/coagulopathy and structural risk.	Stabilize heavy bleeding first, then organize causes as structural vs nonstructural (PALM-COEIN) and choose imaging/endometrial evaluation based on age/risk.
Vaginal discharge / vulvar symptoms	Appearance, odor, pH/microscopy or NAAT context, STI risk, pain, fever, ulcers/lesions and pregnancy status.	Differentiate vaginitis, cervicitis/PID, STI and noninfectious disease; treat partners/testing when indicated and use trauma-informed sexual history.
Pelvic mass / pressure	Age, pregnancy, acute torsion symptoms, fibroid/adenomyosis pattern, ovarian features, ascites, weight loss or postmenopausal bleeding.	Decide whether this is benign-pattern disease, an acute surgical threat or a malignancy workup requiring imaging/biopsy/specialist referral.
Breast complaint	Age, pregnancy/lactation, focal mass, infection signs, skin/nipple changes and screening history.	Distinguish mastitis/abscess and benign mass patterns from findings requiring diagnostic imaging and cancer evaluation.

G. REPRODUCTIVE HEALTH + PREVENTION

Domain	Reasoning anchor
Contraception	Start with the patient's goals, effectiveness preference, contraindications and noncontraceptive benefits. Match method to medical eligibility rather than memorizing a one-size-fits-all hierarchy.
Infertility	Confirm duration/context, ovulation, uterine/tubal factors and semen evaluation. Avoid evaluating only one partner or ordering advanced tests before the basic pathway.
Cervical / gynecologic cancer prevention	Use current age/risk-based screening guidance. Distinguish screening, diagnostic evaluation of abnormal results and surveillance after treatment.
Menopause / osteoporosis	Symptoms, bleeding pattern, bone/cardiovascular risk and medication contraindications. Postmenopausal bleeding is not assumed benign.
Sexual violence / intimate partner violence	Prioritize immediate safety, consent, trauma-informed examination, forensic options where applicable, STI/pregnancy prevention and mandated/institutional processes.

G. REPRODUCTIVE HEALTH + PREVENTION — H. THREE EXAM REFLEXES THAT PREVENT COMMON MISSES

Pregnancy possibility first: a reproductive-age patient with pelvic pain or bleeding often needs pregnancy status established before the rest of the algorithm makes sense.
Stability before specificity: hemorrhage, sepsis or torsion can make the correct next step urgent even before every diagnostic detail is known.
Screening is not diagnosis: abnormal screening results trigger a different pathway from symptomatic disease; know what requires colposcopy, imaging, biopsy or referral conceptually and verify current intervals.

G. REPRODUCTIVE HEALTH + PREVENTION — Direct video repair

APGO - Topic 15: Ectopic Pregnancy	APGO - Topic 45: Abnormal Uterine Bleeding
APGO - Topic 33: Family Planning 2026/27 clerkship-expanded edition - verify school and official exam updates before testing	APGO - Topic 7: Preventive Care / Health Maintenance