Question 2 of 41

A 21-year-old woman, G2P0Ab1, whose last menstrual period (LMP) was 6 weeks ago, complains of vaginal spotting for 1 week and a 3-day history of right lower quadrant pain. Choose the true statement concerning appropriate diagnostic steps:

Urine pregnancy tests are rarely positive before 5 weeks of amenorrhea.

In a normal pregnancy, pelvic sonography can demonstrate an intrauterine sac with a fetal pole by 4 weeks gestation.

Tubal pregnancies are uncommonly visualized with pelvic ultrasound.

Abdominal examination is rarely normal in a patient with ectopic pregnancy.

An adnexal mass rules out an intrauterine gestation.

In any patient presenting with complaints of vaginal bleeding and abdominal pain, ectopic pregnancy must be ruled out. The diagnosis of pregnancy can be made with the new urine pregnancy tests at the time of the first day of missed menses provided the urine is concentrated. Ultrasound can demonstrate a gestational sac in the uterus by 5 weeks gestation and a fetal pole by 6 weeks. The definitive diagnosis of tubal pregnancy (gestational sac with a fetal pole and cardiac motion in the adnexa) by ultrasound is uncommon. In patients with a serum hCG level of 1500 mIU/mL and fluid in the pouch of Douglas or an adnexal mass (and no IUP), ectopic pregnancy is virtually certain. Early ectopic pregnancies may exhibit minimal physical findings. An adnexal mass may represent the normal corpus luteum of an intrauterine pregnancy.

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