A 19-year-old female complains of sudden severe left-sided lower quadrant abdominal pain as well as nausea and vomiting for the last 2 weeks. Last menstrual period was 2 months ago
On physical examination, there is left sided lower quadrant abdominal tenderness and heel strike is positive. Pelvic examination reveals bluish discoloration of the cervix and left-sided adnexal tenderness. These signs and symptoms are consistent with:
A. Ovarian cyst
B. Ectopic pregnancy
C. Pelvic inflammatory disease
D. Follicular cyst
ANS: B
These are key signs of ectopic pregnancy. Amenorrhea in a female of childbearing age should be treated as pregnancy until proven otherwise. Sudden pain is characteristic of tubal ectopic pregnancy, when the embryo outgrows the space within the fallopian tube. The nausea and vomiting are symptoms of early pregnancy. Left-sided lower quadrant pain, bluish discoloration of the cervix, and left-sided adnexal tenderness are all signs of tubal pregnancy. Positive heel strike indicates peritoneal irritation.
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