i-Human Case Study: Week #9 - Ectopic Pregnancy
Presenting as Lower Abdominal Pain and Vaginal
Spotting in a 30-Year-Old Female
This case study is based on the i-Human Patients Academy simulated
patient scenario for Week #9, involving a 30-year-old female presenting
to the emergency room with lower abdominal pain and spotting. The
setup emphasizes differential diagnosis (DDx) play, history-taking,
physical exam, and diagnostic testing in an ER triage setting with
laboratory capabilities. The case is in Learning Mode, with grading
focused on history questions (20%), physical exam (10%), and
diagnostic testing (10%). Below is a comprehensive walkthrough,
including patient details, clinical progression, and management.
Patient Profile
, Name: Jessica Miller
Age: 30 years old
Gender: Female
Height: 5'3" (160 cm)
Weight: 136.0 lb (61.8 kg)
Marital Status: Married
Occupation: Graphic Designer
Living Situation: Lives with husband
Family History: Mother with hypertension; father alive and well;
no significant history of gynecologic cancers or bleeding disorders
Location/Setting: Emergency room - Initial triage and laboratory
capabilities
Chief Complaint (CC)
"Sharp pain in my lower belly and light bleeding for one day."
History of Present Illness (HPI)
The patient presents with sharp, right lower abdominal pain rated 7/10
and light vaginal spotting for one day. The pain is intermittent, lasting
several hours per episode, and described as crampy with occasional
sharp twinges. It is located suprapubically and in the right lower
quadrant, with no radiation to the back, legs, or shoulder. Severity is 4–
6/10, worsening with movement or mild discomfort during urination.
She reports feeling lightheaded and unwell for a few hours but denies
nausea, vomiting, fever, chills, dysuria, urinary frequency, diarrhea, or
constipation. Last menstrual period (LMP) was approximately 6 weeks
ago, with usual cycles of 28–30 days (regular, moderate flow, 4–5 days).
She is sexually active with one male partner (husband), not using
contraception ("not trying, not preventing"), and has inconsistent
condom use. No recent trauma or intercourse noted as triggers.
Obstetric/Gynecologic History:
, Gravida 4, Para 1, Abortions 2 (spontaneous, first-trimester at ages
26 and 28), Living 1 (one spontaneous vaginal delivery of a
healthy male 4 years ago)
Last Pap smear: 1–2 years ago, normal
STI History: Treated chlamydia infection at age 24 (potential PID
risk)
No history of ectopic pregnancy, infertility treatments, or hormonal
contraception currently
Denies foul-smelling vaginal discharge, heavy bleeding, syncope,
or dizziness (beyond lightheadedness)
Past Medical History (PMH) Details
Childhood asthma — Mild, diagnosed in early childhood (around
age 5–8), managed with occasional albuterol inhaler use; no
hospitalizations, no intubations, and fully resolved by adolescence
(no symptoms or medications for >15 years). No current
respiratory issues or triggers noted.
Iron-deficiency anemia (occasional mention in variant cases) —
Mild, history of resolved anemia in early 20s, possibly related to
heavy menses or dietary factors; treated with oral iron supplements
for 3–6 months; no recurrence, no current anemia symptoms or
treatment.
No chronic illnesses — Explicitly negative for:
o Hypertension
o Diabetes mellitus (type 1 or 2)
o Thyroid disorders (hypo/hyperthyroidism)
o Autoimmune conditions (e.g., lupus, rheumatoid arthritis)
o Cardiovascular disease
o Renal or hepatic disease
o Coagulopathies or bleeding disorders
No history of malignancy — No personal or strong family history
of gynecologic cancers (e.g., ovarian, endometrial, cervical) or
other cancers.
Presenting as Lower Abdominal Pain and Vaginal
Spotting in a 30-Year-Old Female
This case study is based on the i-Human Patients Academy simulated
patient scenario for Week #9, involving a 30-year-old female presenting
to the emergency room with lower abdominal pain and spotting. The
setup emphasizes differential diagnosis (DDx) play, history-taking,
physical exam, and diagnostic testing in an ER triage setting with
laboratory capabilities. The case is in Learning Mode, with grading
focused on history questions (20%), physical exam (10%), and
diagnostic testing (10%). Below is a comprehensive walkthrough,
including patient details, clinical progression, and management.
Patient Profile
, Name: Jessica Miller
Age: 30 years old
Gender: Female
Height: 5'3" (160 cm)
Weight: 136.0 lb (61.8 kg)
Marital Status: Married
Occupation: Graphic Designer
Living Situation: Lives with husband
Family History: Mother with hypertension; father alive and well;
no significant history of gynecologic cancers or bleeding disorders
Location/Setting: Emergency room - Initial triage and laboratory
capabilities
Chief Complaint (CC)
"Sharp pain in my lower belly and light bleeding for one day."
History of Present Illness (HPI)
The patient presents with sharp, right lower abdominal pain rated 7/10
and light vaginal spotting for one day. The pain is intermittent, lasting
several hours per episode, and described as crampy with occasional
sharp twinges. It is located suprapubically and in the right lower
quadrant, with no radiation to the back, legs, or shoulder. Severity is 4–
6/10, worsening with movement or mild discomfort during urination.
She reports feeling lightheaded and unwell for a few hours but denies
nausea, vomiting, fever, chills, dysuria, urinary frequency, diarrhea, or
constipation. Last menstrual period (LMP) was approximately 6 weeks
ago, with usual cycles of 28–30 days (regular, moderate flow, 4–5 days).
She is sexually active with one male partner (husband), not using
contraception ("not trying, not preventing"), and has inconsistent
condom use. No recent trauma or intercourse noted as triggers.
Obstetric/Gynecologic History:
, Gravida 4, Para 1, Abortions 2 (spontaneous, first-trimester at ages
26 and 28), Living 1 (one spontaneous vaginal delivery of a
healthy male 4 years ago)
Last Pap smear: 1–2 years ago, normal
STI History: Treated chlamydia infection at age 24 (potential PID
risk)
No history of ectopic pregnancy, infertility treatments, or hormonal
contraception currently
Denies foul-smelling vaginal discharge, heavy bleeding, syncope,
or dizziness (beyond lightheadedness)
Past Medical History (PMH) Details
Childhood asthma — Mild, diagnosed in early childhood (around
age 5–8), managed with occasional albuterol inhaler use; no
hospitalizations, no intubations, and fully resolved by adolescence
(no symptoms or medications for >15 years). No current
respiratory issues or triggers noted.
Iron-deficiency anemia (occasional mention in variant cases) —
Mild, history of resolved anemia in early 20s, possibly related to
heavy menses or dietary factors; treated with oral iron supplements
for 3–6 months; no recurrence, no current anemia symptoms or
treatment.
No chronic illnesses — Explicitly negative for:
o Hypertension
o Diabetes mellitus (type 1 or 2)
o Thyroid disorders (hypo/hyperthyroidism)
o Autoimmune conditions (e.g., lupus, rheumatoid arthritis)
o Cardiovascular disease
o Renal or hepatic disease
o Coagulopathies or bleeding disorders
No history of malignancy — No personal or strong family history
of gynecologic cancers (e.g., ovarian, endometrial, cervical) or
other cancers.
