Examkin

Soru

Zorluk: OrtaDiagnostic Workup and Test Sequencing

A 26-year-old woman presents to the emergency department with a 24-hour history of severe right lower quadrant abdominal pain and light vaginal spotting. In the last hour, she noticed that the pain has started to radiate to her right shoulder. She reports that her last menstrual period was 6 weeks ago, and her past medical history is significant for a prior *Neisseria gonorrhoeae* infection. Vital signs are temperature 37.1 C (98.8 F), blood pressure 118/76 mm Hg, and heart rate 94/min. Abdominal examination demonstrates focal tenderness in the right lower quadrant with voluntary guarding, but no rebound rigidity. Pelvic examination reveals significant right adnexal tenderness without a palpable mass.

Which of the following are the most appropriate initial diagnostic tests to order concurrently to establish the diagnosis? (Select exactly 2)

  1. Transvaginal ultrasonographyCevap
  2. Quantitative serum beta-human chorionic gonadotropinCevap
  3. C
    Diagnostic laparoscopy
  4. D
    Computed tomography of the abdomen and pelvis
  5. E
    Diagnostic dilatation and curettage

Cevap

The most appropriate initial diagnostic tests are transvaginal ultrasonography and quantitative serum beta-human chorionic gonadotropin.
In a hemodynamically stable woman with suspected ectopic pregnancy (indicated by abdominal pain, missed menses, vaginal bleeding, and risk factors like prior sexually transmitted infection), the standard initial diagnostic workup consists of concurrent transvaginal ultrasonography (TVUS) and quantitative serum beta-human chorionic gonadotropin (beta-hCG). The quantitative beta-hCG level determines whether the pregnancy has reached the discriminatory zone (typically 1,500-2,000 mIU/mL), at which point an intrauterine pregnancy should be visible on TVUS. While this patient's shoulder pain suggests possible diaphragmatic irritation from early hemoperitoneum, her normal blood pressure and heart rate indicate hemodynamic stability. This stability allows for completing the standard, non-invasive diagnostic algorithm to avoid unnecessary surgery, radiation exposure, or disruption of a potentially viable early pregnancy.

Adım Adım Çözüm

1
Identify the patient's clinical presentation and stability.
The patient is a reproductive-age female with lower abdominal pain, vaginal spotting, amenorrhea, and referred shoulder pain (Kehr sign), highly suspicious for an ectopic pregnancy. She is hemodynamically stable.
Determining hemodynamic stability is the critical first step because it dictates whether to proceed with standard diagnostic testing or emergent surgical intervention.
2
Determine the appropriate diagnostic sequence for a stable patient.
Concurrent ordering of transvaginal ultrasonography and a quantitative serum beta-human chorionic gonadotropin level is indicated.
This combination allows clinicians to correlate the serum hormone level with the ultrasound findings without exposing the patient to radiation or invasive procedures.

Anahtar Kavram

The initial diagnostic sequence for a hemodynamically stable patient with suspected ectopic pregnancy includes concurrent transvaginal ultrasonography and quantitative serum beta-hCG.
Tahmini Süre:1m 30s
Bu soruyu puanla

Konular

Diagnostic Workup and Test Sequencing

Bu konudan daha fazla soru