Obstetrics & Gynecology Ectopic Pregnancy: Review Questions Scott W. Smilen, MD Dr. Smilen is an associate professor and residency program director, Department of Obstetrics and Gynecology, NYU Medical Center/NYU School of Medicine, New York, NY. Choose the single best answer for each question.
	1. A 21-year-old woman presents to the emergency department with acute onset of left lower abdominal pain that started several hours prior to admission. She describes the pain as crampy and intermittent. Her last normal menstrual period was approximately 6 weeks ago, and she reports spotting for several days prior to admission. Physical examination reveals a tender lower abdomen with guarding, no rebound, no vaginal discharge or cervical motion tenderness, a slightly enlarged soft uterus, and no palpable adnexal masses. The patient’s blood pressure is 110/70 mm Hg, and her heart rate is 80 bpm without orthostatic changes. Which of the following is the most appropriate diagnostic test? Abdominal-pelvic computed tomography (CT) scan Abdominal radiograph Complete blood count Human chorionic gonadotropin (hCG) Progesterone level Click here to compare your answer. 2. A 24-year-old woman who is 7 weeks pregnant with no complaints presents for routine prenatal care and undergoes transvaginal ultrasonography (TVUS), which fails to reveal an intrauterine gestation. The endometrial lining is 4 mm, the ovaries appear normal, and there is a 1.5-cm mass adjacent to the right ovary. There is no gestational sac, yolk sac, or embryo seen in the uterus or adnexae, and no fluid is seen in the cul-de-sac. Serum quantitative hCG level is 4500 mIU/mL. What is this patient’s most likely diagnosis? Complete abortion Ectopic pregnancy Incomplete abortion Missed abortion Threatened abortion Click here to compare your answer.		3.  What is the most appropriate treatment for a hemodynamically stable patient diagnosed with an unruptured ectopic pregnancy via ultrasound without evidence of fetal heart activity (hCG level, 2000 mIU/mL)? Oral methotrexate (MTX) Intramuscular MTX Laparoscopic salpingostomy Laparoscopic salpingectomy Laparotomy with salpingostomy Click here to compare your answer. 4. What is the most common etiologic factor for ectopic pregnancy? Genetically abnormal embryos History of pelvic inflammatory disease (PID) Prior abortion Prior tubal surgery Use of progesterone-only intrauterine devices Click here to compare your answer.
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