USMLE STEP 3 MCQ 11 : A 28 year old with severe left lower quadrant abdominal pain with an eight week history of amenorrhea

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Question:
A 28 year old with severe left lower quadrant abdominal pain with an eight week history of amenorrhea. Her serum elevated human chorionic gonadotropin level is elevated. The most likely diagnosis is

a) dermoid cyst
b) ectopic pregnancy
c) endometrioma
d) follicular cyst
e) corpus luteum cyst

 


Correct Answer: B

Explanation:


Most pregnancy tests are based on the fact that the placenta secretes human chorionic gonadotropin (hCG), a hormone that has a luteinizing action on ovarian follicles and probably has other functions that are not completely known. Serum hCG levels of about 25 milli-international units (mIU)/ ml (IU/L) are reached about 8-10 days after conception Abdominal pain with amenorrhea is the most common presenting complaint in an ectopic pregnancy, and clinicians should have a high index of suspicion for ectopic pregnancy in every woman of reproductive age who presents with these symptoms. Vaginal bleeding is present in only 40% to 50% of patients and may often be mistaken for a normal menstrual period. Patients may also experience the common pregnancy-associated symptoms of nausea and vomiting, breast tenderness, and fatigue


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