A patient at 7 weeks of gestation presents with lower abdominal pain and slight vaginal bleeding. Serum beta-hCG is slightly elevated, and transvaginal ultrasound reveals an empty intrauterine cavity. Which condition does this presentation most strongly suggest?

1. A

   Ectopic pregnancy

2. B

   Threatened abortion

3. C

   Complete abortion

4. D

   Hydatidiform mole

Appeared in: NORCET-11 Prelims

Explanation

• Ectopic pregnancy is suggested by pain, bleeding, positive beta-hCG, and no intrauterine gestational sac.
• Beta-hCG is elevated but not at the level expected for a visible intrauterine pregnancy.
• Transvaginal ultrasound should show a gestational sac by 5.5–6 weeks if intrauterine; absence suggests ectopic.
• Key differentiator: Threatened abortion would show an intrauterine gestational sac.

Why Other Options Were Wrong

• Option B: Threatened abortion presents with vaginal bleeding and possibly pain, but ultrasound would show a live intrauterine pregnancy or at least a gestational sac.
• Option C: Complete abortion would present with a history of heavy bleeding and passage of tissue, and ultrasound would show an empty uterus but beta-hCG would be falling rapidly, not slightly elevated.
• Option D: Hydatidiform mole typically presents with much higher beta-hCG levels, uterine size greater than dates, and ultrasound shows a 'snowstorm' or 'cluster of grapes' appearance, not an empty uterus.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Diagnosis of early pregnancy complications using clinical and imaging findings to guide bedside assessment, documentation, and the next nursing action.
• Early recognition of ectopic pregnancy is critical to prevent tubal rupture and life-threatening hemorrhage.
• Nurses should monitor for signs of hemodynamic instability and escalate care if the patient develops severe pain, hypotension, or syncope.
• What if? If the ultrasound showed a gestational sac with cardiac activity, the diagnosis would shift to threatened abortion, and management would be expectant.

How to Approach the Question

• Identify the key clinical features: gestational age, pain, bleeding, beta-hCG, and ultrasound findings.
• Recall the discriminatory zone for beta-hCG and when a gestational sac should be visible.
• Use the absence of an intrauterine gestational sac with a positive pregnancy test as a red flag for ectopic pregnancy.
• Rule out other causes by matching clinical and imaging findings to typical presentations.
• Prioritize patient safety: ectopic pregnancy is a medical emergency if ruptured.

Concept Tested & Keywords

• Concept Tested: Diagnosis of early pregnancy complications using clinical and imaging findings
• Stem keywords: 7 weeks gestation, lower abdominal pain, slight vaginal bleeding, serum beta-hCG slightly elevated, empty intrauterine cavity, transvaginal ultrasound
• Lead-in keywords: most strongly suggest
• Clinical cues: Pain and bleeding in early pregnancy with empty uterus on ultrasound

Question ID

Q5-cr24NSYsnUA8OMaxRet

Copy ID

Reference Book

E6 Obstetrics Williams pp. 90-95, 4

E6 Medicine Harrison 22e Part 2 p. 1040-1042