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  • September 13, 2024
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  • 2024/2025
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uWise Ectopic Pregnancy Questions with 100%
Correct Answers | Latest Version 2024 | Expert
Verified

A e30-year-old eG3P2 ewoman, ewhose elast enormal emenstrual eperiod ewas eeight eweeks eago, ebegan
espotting ethree edays eago eand edeveloped ecramping ethis emorning. eShe ehas ea ehistory eof ea echlamydia


einfection ewith ea eprevious epregnancy. eShe esmokes eone epack eof ecigarettes eper eday eand edenies ealcohol


eor edrug euse. eOn ephysical eexam: eblood epressure e120/70; epulse e82; erespirations e20; eand etemperature


e98.6°F e(37.0°C). eAbdominal eexamination eis enormal. ePelvic eexamination ereveals eold eblood ein ethe


evaginal evault, eclosed ecervix ewithout elesions, eslightly eenlarged euterus eand eno eadnexal etenderness.


ePertinent elabs: equantitative eBeta-hCG eis e1000 emIU/ml; eurinalysis enormal; ehematocrit e= e32%.


eTransvaginal eultrasound eshows eno eintrauterine epregnancy, eno eadnexal emasses, eand eno efree efluid ein


epelvis. eWhich eof ethe efollowing eis ethe emost eappropriate enext estep ein ethe emanagement eof ethis epatient?


e- eCorrect e eAnswer e- eCorrect! eThe epatient ehas erisk efactors efor eectopic epregnancy, ebut eneeds ean


eaccurate ediagnosis ebefore ea etreatment eplan eis eentertained. eRepeating ethe eBeta-hCG eis ethe enext estep


ein ethis epatient's emanagement. eInappropriately erising eBeta-hCG elevels e(less ethan e50% eincrease ein e48


ehours) eor elevels ethat eeither edo enot efall efollowing ediagnostic edilation eand ecurettage ewould ebe


econsistent ewith ethe ediagnosis eof eectopic epregnancy. eAlternatively, ea efetal epole emust ebe evisualized


eoutside ethe euterus eon eultrasound. eThe epatient ewould eneed ea eBeta-hCG elevel eover ethe ediscriminatory


ezone e(the elevel ewhere ean eintrauterine epregnancy ecan ebe eseen eon eultrasound) ewith ean eempty euterus.


eThe elevel ecommonly eused eis e2000 emIU/ml. eTreatment ewith emethotrexate emay ebe eappropriate, ebut


eonly eafter ea edefinitive ediagnosis eis emade. eThe epatient edoes enot eyet ehave ethis elevel eand eis estable. eShe


eis, etherefore, enot ea ecandidate efor eexploratory esurgery. eIf eshe ehad eunstable evital esigns eor ean eacute


eabdomen, ea ediagnostic elaparoscopy/laparotomy ewould ebe eindicated. eRepeating ethe eultrasound ein eone


eweek eis enot erecommended ebecause ea edelay ein ediagnosis ecould eresult ein ea eruptured eectopic epregnancy


eand eincreased erisk eto ethe epatient. eThe epatient eis ehemodynamically estable; etherefore, eshe edoes enot


eneed eto ebe eadmitted eto ethe ehospital.




A e33-year-old eG3P1 ewoman epresents ewith eleft elower equadrant epain eof etwo edays eduration eand eseven
eweeks eof eamenorrhea. eShe edescribes eher epain eas emild eand eintermittent. ePast emedical ehistory eis


esignificant efor esmoking eduring eher eteens, eectopic epregnancy ewith esalpingostomy efour eyears eago,


emultiple eChlamydia einfections ein eher eteens, eand ean euncomplicated eCesarean edelivery efor ebreech


epresentation. eWhich eof ethe efollowing erisk efactors eis emost elikely eassociated ewith erecurrent eectopic


epregnancy ein ethis epatient? e- eCorrect e eAnswer e- eCorrect! eThere eis ea etenfold eincrease erisk efor eectopic


epregnancy ein ewomen ewith ea eprior ehistory eof eectopic epregnancy. eAge ebetween e35 eand e44 eyears eold eis

, eassociated ewith ea ethreefold eincrease ein eectopic epregnancy. ePrior eabdominal esurgery eand ehistory eof
esexually etransmitted einfections eas ewell eas esterilization efailures, eendometriosis eand econgenital euterine


emalformations eare eall eassociated ewith ean eincreased erisk eof eectopic epregnancy. eThe einterval ebetween


epregnancies eand epast esmoking ehistory eis enot eassociated ewith ean eincreased erisk eof eectopic epregnancy.




A e17-year-old eG2P0 efemale ehas esevere eright elower equadrant epain. eHer elast enormal emenstrual eperiod
ewas eseven eweeks eago. eShe enotes ethat elast enight eshe ebegan ehaving esuprapubic epain ethat eradiated eto


eher eright elower equadrant. eThis emorning, ethe epain eawoke eher efrom esleep. eShe ehas ehad eno evaginal


ebleeding, eno enausea eor evomiting. eThe epatient's ehistory eis enotable efor etwo efirst etrimester eelective


eabortions eand ea ehistory eof echlamydia etreated etwice. eVital esigns eare eblood epressure e90/60; epulse e99;


erespirations e22; eand etemperature e98.6°F e(37°C). eOn ephysical eexam, ethe epatient eis enoted eto ebe ecurled


eon ea estretcher ein ea efetal eposition eand esays eshe ehurts etoo emuch eto emove. eShe ehas erebound eand


evoluntary eguarding eon eabdominal eexamination. eShe ehas esevere ecervical emotion etenderness eand erectal


etenderness. eHer eBeta-hCG elevel eis e2500 emIU/ml; ehematocrit e24%; eand eurinalysis enegative. eUltrasound


eshows eno eintrauterine epregnancy, ea eright eadnexal emass e- eCorrect e eAnswer e- eIncorrect! eCorrect eanswer


eis eB. eThis epatient ehas ea eruptured eectopic epregnancy euntil eproven eotherwise. eHer evital esigns,


eexamination eand eanemia eare econsistent ewith ean eintra-abdominal ebleed. eExploratory


elaparoscopy/laparotomy eis eindicated eat ethis epoint. eConservative emanagement ewith eobservation, eserial


eexaminations eor erepeat eBeta-hCG etesting ecould ebe edangerous ein ea epatient esuspected eof ehaving ea


eruptured eectopic epregnancy. eMedical emanagement e(methotrexate) eis enot eused ein ea epatient ewith ean


eacute esurgical eabdomen. eDilation eand ecurettage ewould enot ebe ethe enext estep ein emanagement eand


emight eonly ebe econsidered ein ethis escenario eafter ethe epatient's eabdomen ewas eexplored.




A e19-year-old eG2P1 ewoman epresents ewith evaginal espotting eand euterine ecramping. eHer elast enormal
emenstrual eperiod ewas esix eweeks eago eand eshe ebegan espotting ethree edays eago. eShe ehas eno ehistory eof


esexually etransmitted einfections. eHer evital esigns eare eblood epressure e120/70; epulse e78; erespirations e20;


eand etemperature e98.6°F e(37.0°C). eOn epelvic eexamination, eshe ehas eno ecervical emotion etenderness, eher


euterus eis enormal esize eand enon-tender; eno eadnexal emasses eare epalpable. eQuantitative eBeta-hCG e48


ehours eago ewas e1500 emIU/ml. eCurrently, eBeta-hCG eis e3100 emIU/ml. eProgesterone eis e26 eng/ml;


ehematocrit eis e38%; eand eurinalysis eis enormal. eWhat eis ethe emost elikely efinding eon etransvaginal


eultrasound? e- eCorrect e eAnswer e- eCorrect! eTransvaginal eultrasound ewill emost elikely eshow ean


eintrauterine epregnancy. eThe eBeta-hCG elevel eis eabove ethe ediscriminatory ezone efor eultrasound e(2000


emIU/ml), eand ethe elevel ehas edoubled ein e48 ehours. eAdditionally, ethe eprogesterone elevel eis ewithin


eexpected erange efor ea enormal epregnancy e(>25 eng/ml esuggests ehealthy epregnancy) eand eup eto e30% eof


eall enormal epregnancies eexperience efirst etrimester espotting/bleeding. eThe efindings eof edebris ein ethe


euterus, ean eempty euterus, ewith eor ewithout ean eadnexal emass, eor efree efluid e(suggesting


ehemoperitoneum) ewould enot ebe eanticipated.




A e20-year-old eG1P0 ewoman ehas evaginal espotting eand emild ecramping efor ethe elast ethree edays. eHer elast
enormal emenstrual eperiod ewas eapproximately eseven eweeks eago. eShe ehad ea epositive ehome epregnancy


etest. eVital esigns eare: eblood epressure e120/72; epulse e64; erespirations e18; etemperature e98.6°F e(37°C). eOn


epelvic eexam, eshe ehas escant eold eblood ein ethe evagina, ewith ea enormal eappearing ecervix eand eno


edischarge. eOn ebimanual eexam, eher euterus eis enontender eand esmall, eand ethere eare eno eadnexal emasses

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