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Ectopic Pregnancy — RACP Adult Medicine MCQ

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EasyGeneral Internal MedicineEctopic PregnancyRACP Adult Medicine

A 30-year-old woman presents with right iliac fossa pain. She is 8 weeks pregnant. Serum beta-hCG is 5,500 IU/L. Transvaginal ultrasound shows no intrauterine pregnancy and a 3 cm right adnexal mass with a fetal heartbeat. What is the diagnosis and management?

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Correct answer: D — Ectopic pregnancy – urgent surgical management (laparoscopy)

An adnexal mass with a fetal heartbeat and no intrauterine pregnancy confirms an ectopic pregnancy – a gynaecological emergency. With a live ectopic and adnexal mass >3.5 cm, surgical management (laparoscopic salpingectomy or salpingotomy) is indicated. Medical management with methotrexate is appropriate for smaller, unruptured ectopics with declining beta-hCG and no fetal heartbeat. All Rh-negative women should receive anti-D immunoglobulin. This question tests the physician trainee's ability to recognise and initiate management of a common emergency even outside their primary specialty.

Reference: eTG – 2025 – Obstetrics; RANZCOG – 2024 – Ectopic Pregnancy Guidelines