Lim
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A 23-year-old white female presents with a 3-day history of intermittent lower abdominal pain of mild to mederate severety and vaginal spotting. Her last menstrual period was 6-weeks ago. On examination, she is afebrile and unilateral adnexal tenderness is present. Pregnancy test is positive. Transabdominal US reveals no intrauterine gestation. Quantitiative beta-HCG is 800mlU/ml. Her vitals are, BP 110/80 mmHg PR 80/min RR 18/min Temp 36.7C(98F). According to these findings, which of the following is the most appropriate next step?
a. Culdocentesis
b. Laparoscopy
c. Gram stain and culture of cndocervical secretions
d. Transvaginal ultrasonogram
e. Laparotomy
this Q shows some difference between UW and Kaplan.
TransVaginal Sono needs more than 1500mlU/ml???
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| dermatology
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A wud b my answer...,
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| dermatology
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i guess most accurate test wud b transvaginal ... but appropriate step wud b culdocentesis to rule out ruptured ectopic .....
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| Lim
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dermatology,thanks.
hCG level is 800, don you think transvaginal sonogram is appropriate?(i mean possible?)
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| elitoki
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I think the Answer is D.
This pte has 6 wk of pregnancy calculating from LMP. In normal pregnancy after 5 or 6 wk should have more than 1000 to 56,000 of beta hCG. but she has low ( that is one of possible point to suspect ectopic pregnancy) Transvaginal is more sensitive than transabdominal, so u have to do it before futher other study in low beta hCG.
I don't think this pte has rupture ectopic pregnancy. her symptoms are mild to moderate, and her vital sign's are normal. if she present rupture ect preg, she should be on distress with more symptoms. so, I think culdocentesis can be done after vagital usg.
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| Lim
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Anser is D
elitoki, thanks.
GA is also important.
and i misundersood the kaplan.
In kaplan, qualitiive hCG(+) AND Sono no IUP,no Ectopy
go Quantative hCG
ex) 1800 : Ectopy -> Laparoscopy
1100 : too early and check again after two days : 2200 : IUP
1600 : Laparoscopy
when we're talking about GA in usmle. it's calculated by Menstrual Dating. right?
that was also my bias too...(cause she would be 6-week GA.)
i thought from her ovulating time..so i thought she could be in 4 or less weeks GA.(which is totally wrong.)
thanks elitoki again.
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